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  IN THIS Article
 ::  Abstract
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  References

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CASE REPORT
Year : 1993  |  Volume : 39  |  Issue : 2  |  Page : 98-9

Hemihaematometra with persistent undeveloped Wolffian duct.


Dept of Obstetrics and Gynaecology, Seth GS Medical College, Bombay, Maharashtra.

Correspondence Address:
S P Saharan
Dept of Obstetrics and Gynaecology, Seth GS Medical College, Bombay, Maharashtra.

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Source of Support: None, Conflict of Interest: None


PMID: 0008169875

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 :: Abstract 

A case of hemihaematometra in a non-communicating rudimentary horn of the uterus in a 14 year old girl is presented. Exploratory laparotomy revealed a persistent undeveloped Wolffian duct. This is the second case in world literature where a persistent mesonephric duct without any development is reported.


Keywords: Abnormalities, Multiple, diagnosis,surgery,Adolescent, Case Report, Female, Hematometra, diagnosis,etiology,Human, Kidney, abnormalities,Uterus, abnormalities,Wolffian Duct, abnormalities,


How to cite this article:
Saharan S P, Parulekar S V. Hemihaematometra with persistent undeveloped Wolffian duct. J Postgrad Med 1993;39:98

How to cite this URL:
Saharan S P, Parulekar S V. Hemihaematometra with persistent undeveloped Wolffian duct. J Postgrad Med [serial online] 1993 [cited 2020 Apr 5];39:98. Available from: http://www.jpgmonline.com/text.asp?1993/39/2/98/623





  ::   Introduction Top


Rudimentary horn of the uterus is produced when development of one Mullerian duct is normal and that of the other imperfect. Some of these rudimentary horns are non-communicating and are connected to the uterus by fibrous bands[1]. In some, the endometrium is non-functional, so no clinical symptoms are present. Retention of menstrual blood in a non-communicating rudimentary horn with a functional endometrium causes pain, which is aggravated during menstruation. Maldevelopment of Mullerian ducts, is associated with urinary tract anomalies in many cases[2],[3]. One such case of hemihaematometra in a rudimentary horn of the uterus with absence of the right kidney and a persistent undeveloped Wolffian duct is presented.


  ::   Case report Top


A 14-year-old, single, girl presented with chronic pain in the right iliac fossa and dysmenorrhoea since 6 months. She had attained menarche at the age of 11. Her menstrual cycles were irregular, painful, lasting for 3 days at intervals of 2-2 months. On per vaginal examination, a nontender, smooth, not freely.mobile mass measuring 4 cm in diameter was felt in the right fornix; a single cervix was felt. Uterus was of normal size deviated to the left and closely connected to the pelvic mass.

Ultrasonography showed a normal uterus deviated to the left. There was a large collection 4.2x4.1 cm surrounded by myometrial echo attached to the normal uterus on its right side. The right kidney was absent. A tentative diagnosis of a hemihaematometra was made.

Laparoscopy was done which showed normal tubes and ovaries. A bicornuate uterus with the right horn measuring 5 cm x 4 cm was seen. An intervening band of adhesions was present between the right and the left horn, which was normal in size. A sound passed into the cervix could be negotiated into the left horn only. There was no evidence of endometriosis. In order to confirm that there was no communication between the horns[4], it was decided to observe the patient over 3 menstrual cycles for increase in the size of the haematometra. After 3 months, the patient had no relief from pain and ultrasonography revealed that the size of the horn had enlarged to 6x3x2 cm.

An exploratory laparotomy was done. The absence of the right kidney was confirmed and from the back of the cervix, extraperitoneally, there was a tubular structure going up towards the pelvic inlet, along the course of the ureter. This was resected further up. On the right side, a pyosalpinx was found which was dissected. The rudimentary horn was found expanding downwards on the pelvic floor. It was dissected and excised. The abdomen was closed in layers. The patient made an uneventful recovery and was discharged.


  ::   Discussion Top


The anomalous tubular structure coursing along the pelvic wall extraperitoneally was along the course of the ureter in the upper part. It terminated on the back of the cervix. There was no development of ureter and the kidney on the right side. The mesonephric duct may rarely grow, but not develop into the ureter in an adult. Such an anomaly has to be associated with ipsilateral absence of the kidney, which develops from the metanephros where it comes into contact with the metanephric duct. There is only one case of this kind reported in world literature[5].

Careful history and examination reveals the diagnosis of a rudimentary horn of the uterus in many cases. Availability of ultrasonography makes the diagnosis easier. This is excised because it leads to the development of a haematosalpinx and haematometra and later to endometriosis. Attempts at establishing a connection with a normal cervix often fail[6],[7],[8].

 
 :: References Top

1. Jones HW, Wentz AC, Burnett LS. Novaks Text Book of Gynaecology, 11th ed. Baltimore, Hongkong, London: Williams and Wilkins; 1988, pp 150-151.  Back to cited text no. 1    
2.Jeffcoate N. Principles of Gynaecology, 4th ed. London, Boston, Sydney: Butterworth World Student Reprints; 1975, pp 135.  Back to cited text no. 2    
3.Wiersma AF, Facog MD, Lowell F. Uterine anomalies associated with unilateral renal agenesis. Obstet Gynaecol 1976; 47: 654-657.  Back to cited text no. 3    
4.Heinonen PK, Saarikoski S, Pystynen P. Reproductive performance of women with uterine anomalies. Acta Obstet Gynaecol Scand, 1982; 61:157-161.  Back to cited text no. 4    
5.Parulekar SV. Persistent undeveloped mesonephric duct. J Post grad Med 1990; 36:54-55.  Back to cited text no. 5    
6.Mattingiy RF, Thompson JD. Te Linde's Operative Gynaecology, 6th ed, Philadelphia, Toronto, Tokyo: JB Lippincott Company; 1985, pp 349.  Back to cited text no. 6    
7.Mattingly RF, Thompson JD. Ibid 1985; 365.  Back to cited text no. 7    
8.Mattingly RF, Thompson JD. Ibid 1985; 375.   Back to cited text no. 8    



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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow