Ruptured Bicornuate Uterus Mimicking Ectopic Pregnancy:A Case Report

Introduction: Congenital malformations of uterus occur due to abnormal formation, fusion or resorption of mullerian ducts during fetal life. A normal uterus is formed by fusion of two mullerian ducts which starts at 10^th week and uterine development is completed by 20^th week. If the two mullerian ducts fail to fuse it results in separate uterine horns also known as Bicornuate uterus.

Presentation of Case: We are presenting a case of 24 year old primigravida presented to us at 15^th weeks of gestation who was having amenorrhoea for 3 months and 26 days along with gaseous distention of abdomen and lower abdomen pain for 6-7 days. She again underwent an abdominal ultrasonography at a different centre and it was suggestive of abdominal pregnancy. She underwent an abdominal ultrasonography again after 2 weeks of this where she was diagnosed as abdominal pregnancy with minimal as cites. To take further advice she presented to us the next day with both the reports. An assessment of ectopic pregnancy was made, she was counselled and consent for lapratomy was taken. At surgery a gravid bicornuate uterus with pregnancy in left cornua was found. Tubes and ovaries were normal. The conceptus ruptured the left uterine wall and the omentum was found adhered to the uterus. Omentum was ligated. The ruptured left horn was removed at its junction to right horn. Product of conceptus was taken out, pelvis was drained of blood and uterus and abdomen were closed in layers after achieving complete hemostasis.

Discussion: Our patient had ultrasonographic diagnosis of abdominal pregnancy at 15^th week so an emergengency laparotomy was done to save patients life. On laparotomy bicornuate uterus with ruptured pregnancy in left horn was found. Blood, fluid replacement therapy and exploratory laparotomy followed by repair of uterus and drainage of pelvic blood was necessary to save patients life.

Conclusion: This case highlights the fact that a bicornuate uterine pregnancy can mimc an ectopic pregnancy and the two should be differentiated.