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| Name | A Rare Case of a Secretory and Obstructed Uterine Horn Fistulized to an Ipsilateral Rudimentary Uret |
| Video Uploader | Video From CanSAGE Secretariat |
| Upload Date | This Video Uploaded At 30-10-2024 18:28:58 |
| Video Discription | This video demonstrates the laparoscopic management of a rare case of a secretory and obstructed uterine horn with a fistula to a rudimentary ureter, detailing a cornuectomy and excision of endometriosis to address severe pelvic pain and complex anatomical challenges. See full transcript here: www.cansagevideos.com/rare-case-secretory-obstructed-uterine-horn-rudimentary-ureter/ Presented By Dr. Azelie Paulus Dr. Kristina Arendas Dr. Madeleine Lemyre Dr. Phillippe Laberge Dr Sarah Lacroix Maheux Affiliations University Laval Timestamps (00:29) Patient (00:57) Congenital Malformations of the Female Genital Tract (01:16) Laparoscopic Cornuectomy (01:33) Main Surgical Steps (01:42 - 06:22) Procedure Video (06:23) Take Home Message: Mullerian Malformations The video presents a rare and complex case involving a secretory and obstructed rudimentary uterine horn, fistulized to a rudimentary ureter, in an 18-year-old patient with severe pelvic pain and anemia. Pre-operative MRI revealed a range of complications, including a fistula between the uterine horn and ureter, the absence of an ipsilateral kidney, and deep infiltrative endometriosis. This congenital Mullerian anomaly required a thorough surgical plan, and the patient underwent a laparoscopic cornuectomy combined with resection of the hemato-ureter and excision of endometriosis lesions. The surgical team initiated preoperative GnRH therapy to suppress menstruation, aiding in pain control and surgical preparation. The surgical procedure began with hysteroscopy to confirm obstruction, followed by laparoscopy to resect the obstructed horn and associated endometriosis. Vasopressin was injected into the fibromuscular band to control bleeding, and a dual ultrasonic and bipolar device was used for precise myometrial dissection. The obstructed cavity and associated hemato-ureter were meticulously dissected and removed to prevent recurrent complications. Following the cornuectomy, morcellation allowed for safe extraction of excised tissues, and additional exploration and excision of endometriosis were performed to optimize pain management and future fertility outcomes. To ensure the procedure's success, hysteroscopy was repeated to verify the thickness of the remaining myometrium and confirm no connection with the main uterine cavity. A reinforcing X suture was placed to secure the cornuectomy site, while cystoscopy confirmed the absence of ureteral connection on the affected side. Careful coordination among the surgical team, along with thorough imaging and planning, were crucial in achieving a complete resection of the complex malformation and associated endometriosis. This case exemplifies the challenges and precision required in managing complex Mullerian anomalies with accompanying renal and endometriotic complications. Successful outcomes depend on comprehensive preoperative imaging and a skilled surgical team to navigate the intricate anatomical variations involved in such rare conditions. |
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