Maimoona Mushtaq, Iram Akhtar.
Congenital Uterine anomalies clinical presentations.
J Pak Inst Med Sci Jan ;15(1):877-80.

A 22 years old nulliparous woman, married for last 3 years was seen in gynecology clinic for the treatment of primary infertility. She had been living with her husband for irregular periods and never contacted any infertility clinic for treatment. Her age of menarche and menstrual history since then seemed normal and she was having good marital relations. Her husband was a healthy male of average height and built with no previous history of gross medical illness or surgical intervention. Her abdominal examination along with other system examinations revealed no abnormality, however, on pelvic examination there was a mass in right fornix and the size was around 12 weeks. All other investigations along with husband`s semen analysis were within normal limits. Ultrasound pelvis revealed that the uterus was displaced towards the left side by a large cystic loculated mass and a solid mass inseparable from right side of uterine wall. The solid area suggestive of multiple cysts right adenexal region and a large subserosal fibroid adjacent to right wall of uterus. Exploratory laparotomy was planned to identify. On opening the pelvic cavity, a large endometriotic ovarian cyst on the right side, measuring 10x10 cms, was found. Left side ovary and tube were healthy. Both tubes had a separate uterine cornu. There was a central mass of about 8 cms. The endometriotic cyst on the right side was drained, cyst wall removed and healthy ovarian tissue was conserved. The central mass was incised, it contained altered blood and had connections with both cornu but there was a thick septum, which was obstructing the outflow tract, which was excised. Uterine reconstruction was performed by approximating the two healthy edges of the uterus, resulting in a single uterine cavity with a single outflow tract through cervix and vagina, both tubes opening at their respective cornu. Hysterosalphingogram performed after 6 months, confirmed normal configuration of uterine cavity and patent fallopian tubes. Final Diagnosis: Uterus didelphus (bicornis) unicollis with a thick vaginal septum dividing the vagina into a blind pouch and a right normal vagina. Each member had a single normal tube and an associated normal ovary.

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