Unidentified chronic pelvic pain due to hematometra non-communicating left horn uterus unicornuate with history of abdominal pregnancy

Introduction: This study aimed to characterize unicornuate uterus with noncommunicating horns, an uncommon Müllerian abnormality. With a 0.06 % incidence rate, this disorder can lead to endometriosis linked to retrograde menstruation or hematometra, which can cause significant pelvic pain. Case presentation: A 39-year-old woman with chief complaints of severe dysmenorrhea for five years. Despite receiving hormone therapy, the patient's symptoms persisted. She has only one living child born at laparotomy for an abdominal pregnancy 19 years ago. Upon ultrasound inspection, a 2.8 × 3 cm endometrioma was the only finding. Prior to her laparoscopic procedure, the woman had a unicornuate uterus on her right side with a normal cervix, and also a non-communicating hemiuterus in her left horn that had burst due to adhesion separation and was leaking chocolate fluid. On the left side, there was also a 3 × 3 cm endometrioma. Following that, a laparoscopic hysterectomy was carried out. Discussion: Although misread occasionally, the correct diagnosis of a unicornuate uterus with a noncommunicating horn is clinically important. The history of this patient's abdominal pregnancy may have developed in the rudimentary horn after sperm or fertilized eggs moved trans peritoneally, with life-threatening consequences if ruptured. This patient developed severe dysmenorrhea after receiving hormonal therapy, possibly caused by a noncommunicating left horn uterine hematometra and endometrioma. In this case, a laparoscopic hysterectomy was afterward chosen due to the patient's request according to her symptoms. Conclusion: Unicornuate uterine with non-communicating horns is scarce however may cause severe complications. Considered a treatment to prevent related morbidity, laparoscopy is necessary to affirm the diagnosis.