Background

• Congenital uterine anomalies (CUA) are defined as anatomical variances in uterine structure, caused by anomalous embryological development of the paramesonephric ducts. 

• Uterus didelphys is a CUA characterised by two fusiform endometrial cavities separated by a large fundal cleft, with distinct endocervical canals and a single ovary each.

• The majority of CUA cases are asymptomatic; however symptomatic patients experience an increased risk of recurrent miscarriage, infertility and preterm delivery, which can have a negative biopsychosocial impact.

• CUAs with significant reproductive impact such as uterus didelphys necessitate discussion regarding whether early identification and patient education might ameliorate reproductive outcomes.

Case Presentation

• A 17 year old woman presented to the Emergency Department with severe sudden onset left iliac fossa pain, vomiting and rigors. Gynaecological history established a since-resolved, isolated episode of offensive, yellow vaginal discharge several months prior, with no previous sexually transmitted infection screening and no history of penetrative intercourse. Past medical history of left-sided renal agenesis.

• Laboratory results were indicative of infection, with an elevated white cell count and C-reactive protein;urinalysis excluded pregnancy as a differential diagnosis. A transabdominal ultrasound identified a left adnexal collection, which CTAP discerned to be uterus didelphys with mixed left-sided pyometra and haematometra.

• Diagnostic laparoscopy with abdominopelvic washout and examination under anaesthetic confirmed uterus didelphys; left cervical stenosis was surgically corrected by dilatation and monopolar salpingotomy assisted drainage.