Publication:

Diagnostic challenges in chronic pelvic pain: delayed diagnosis of a functional non-communicating rudimentary horn mimicking benign gynaecologic disease: a case report and literature review

Functional non-communicating rudimentary horn is a rare Müllerian anomaly that may remain undiagnosed until adulthood because its presentation often mimics common gynecological conditions. Delayed diagnosis can result in chronic pelvic pain, severe dysmenorrhea, and prolonged ineffective treatment. A 32-year-old multiparous woman with two previous caesarean deliveries presented with chronic pelvic pain and severe dysmenorrhea for two years, refractory to medical therapy. Previous evaluations suggested fibroid uterus, endometrioma, adnexal mass, and ectopic pregnancy. Three-dimensional transvaginal ultrasonography identified a left-sided functional non-communicating rudimentary horn with hematometra. Surgical excision was performed, and histopathological examination confirmed the diagnosis. The postoperative course was uneventful, with complete resolution of pelvic pain and dysmenorrhea. A focused literature review of reported cases with delayed diagnosis or misdiagnosis demonstrated that chronic pelvic pain and dysmenorrhea were the most common presenting symptoms, while endometriosis, fibroids, and pelvic masses were frequent alternative diagnoses. Surgical excision resulted in symptom improvement in all reviewed cases. This case highlights the diagnostic challenges associated with functional non-communicating rudimentary horns, particularly in adult women with previous successful pregnancies. Müllerian anomalies should be considered in patients with refractory dysmenorrhea and chronic pelvic pain despite conventional treatment. Early use of advanced imaging modalities, especially three-dimensional ultrasonography, can facilitate timely diagnosis and definitive management, thereby reducing diagnostic delays and associated morbidity.