Objective:A case of uterine didelphys with endometriosis & subfertility wrongly diagnosed as bicornuate uterus 

Case Report: 37 year old female presented to gynae emergency as lower abdominal pain with vomiting. On examination  abdomen is tender in left iliac fossa. Patient was a known case of bicornuate uterus (diagnosed on laparoscopy few years back), PCOS & endometriosis. Patient was diagnosed as case of dysmenorrhea, discharged home after analgesics & antiemetic. After 2 weeks she attended fertility clinic, where HyCosy & 3D scan was done by consultant which shows uterine didelphys with left horn not communicating to the cervix, left sided hematometra & left ovary with endometriotic changes. MRI again shows bicornuate uterus. So diagnosis ?? Uterine abnormality with significant endometriosis ?? Uterine didelphys with left horn not connected to the cervix.

Surgery done which includes hysteroscopy & laparoscopy, left salpingo-oopherectomy  & left hemi hysterectomy & tubal dytest & adhesion lysis. Left ureter not visualized as left renal agenesis was found.

Follow-up shows markedly improved quality of life with no pain.

Discussion:This case shows that gold standard in diagnosis of uterine didelphys is 3D TVS & saline infusion sonography, as it clearly identifies non communicating horn in this case

Conclusion: Uterine abnormalities are often associated with renal anomalies. Proper diagnosis & management improves quality of life. Most women have normal reproductive outcome but patient should be told about increased risk of miscarriages, preterm labor, fetal malpresentations, also FGR & pre eclampsia.