A 19-year-old presented to our hospital with spontaneously conceived twin pregnancy at 14 weeks. She was misdiagnosed at her cityas a case of pregnancy upon which MRI was done. MRI showed right cystic complex ovarian lesion 6.5*7 cm with empty endometrium (Figure 1).

Figure 1: MRI showing right complex cystic lesion.

Laparoscopy was done showed a uterus with a rudimentary horn. A few days later after laparoscopy, she presented to our hospital. At presentation, she was asymptomatic and denied abdominal pain, vaginal bleeding, chest pain, and syncope. She had no previous history of infertility or confirmed renal anomaly.

On examination, the woman was vitally stable. Abdominal examination revealed a lax abdomen with no evidence of tenderness or rigidity. A mass was felt 3cm above pubis. Vaginal examination showed a single cervix. A mobile mass was felt filling the right lateral. An ultrasound examination was done on admission revealed twin pregnancy related to upper right border of uterus (Figure 2).

Figure 2: twin pregnancy related to right upper uterine border.

The woman was counselled about laparotomy and excision of the rudimentary horn containing pregnancy prior to be ruptured. Surgical consents were broad for possible bladder intestinal or vascular injuries. The patient underwent exploratory laparotomy through an incision. , twin pregnancy was found contained within a rudimentary uterine horn (Figure 3).

Figure 3: A distended right rudimentary horn with twin pregnancy.

Excision of the horn containing pregnancy was done followed by right (figure 4 and 5)

Figure 4: removal of the rudimentary horn.

       Figure 5: The unicornuate uterus which was left after the laparotomy.

Ensuring was done abdomen was closed. The course was uncomplicated. The patient was discharged on the next day postoperative. Final Pathology revealed.