Unintended hemihysterectomy due to a unicornuate uterus: clinical lessons and case report.

BACKGROUND

For patients with a unicornuate uterus and a symptomatic rudimentary horn, the definitive treatment is surgical removal of the horn, which can be performed using either laparoscopy or laparotomy. Usually, the rudimentary horn appears smaller than the unicornuate uterus. We present a rare case in which this was not the case, with the aim of sharing the serious consequences of incorrect operation and attempting to summarize a standardized preoperative protocol for such patients.

CASE DESCRIPTION: We report a case of mistaken hemihysterectomy of a unicornuate uterus in a nonparous young woman. The left rudimentary horn of the uterus was mistakenly removed during the surgery by an outside surgeon. The right uterine horn measured 4.7 cm × 4.1 cm × 4.0 cm, while the left horn measured 4.9 cm × 2.2 cm × 2.9 cm. The patient had a history of dysmenorrhea since menarche at age 12 years, and the surgery was performed at the outside hospital at age 24 years old. Upon referral to West China Second University Hospital, we performed a comprehensive preoperative workup, including three-dimensional ultrasound (3D-US) and magnetic resonance imaging (MRI), to carefully assess the uterine anatomy. A multidisciplinary approach involving gynecologist, radiologist, reproductive specialists, and surgeon was taken to finalize the diagnosis and ensure proper management. The patient underwent appropriate treatment at age 25 years old. The pain was completely relieved after surgery and the patient showed no further complications with a 1-year follow-up.

CONCLUSIONS

It is still a painful lesson, and we should remain vigilant when managing such rare anomalies. Key lessons learned include not relying solely on size for identification, exercising extra caution when encountering a "horn", and emphasizing the use of advanced imaging techniques such as MRI and ultrasound as well as a cautious surgical plan. A thorough post-surgical plan, including counseling and potential reconstructive options, should be considered to manage any complications resulted from a catastrophically incorrect surgery and to preserve the patient's health. Ensuring meticulous preoperative evaluation and comprehensive surgical planning can significantly reduce the risk of surgical errors.