Rupture of Didelphys Uterus and Coexistence of Intestinal Diverticulum in an 18 Years Old Primigravida: A Case Report.

Uterine didelphys, also known as double uterus, is a congenital anomaly of the female reproductive system that can be associated with a significant number of threatening obstetric complications, such as uterine rupture. We report a rare and complex case of an 18-year-old primigravida who presented with uterine rupture due to uterine didelphys at 18 weeks of gestation. Patient had no prior medical or gynecological history. Physical examination revealed a diffusely distended and tender abdomen along with signs of hemodynamic instability. Ultrasound of the abdomen showed hemoperitoneum, with an intrauterine dead fetus. Second trimester intrauterine rupture was considered the initial diagnosis. After successfully resuscitating the patient, exploratory laparotomy was performed. Uterine didelphys with a right-sided uterus ruptured from the fundal region along with a wide-bore intestinal diverticulum was seen. After repairing the uterus in 2 layers and hemodynamically supporting the patient, retained products of conception were removed. Postoperative laboratory investigations were significant for disseminated intravascular coagulation and metabolic acidosis with respiratory compensation. These critical findings necessitated intensive care unit (ICU) admission where the patient received close monitoring, ultimately leading to stabilization of the patient. This case serves as a reminder that adolescents with Mullerian duct anomalies, even without a prior history of uterine scarring, can present with life-threatening obstetric complications such as uterine rupture. Prompt recognition and timely management are essential to prevent fatal outcomes.