Rupture of Bicornuate Uterus: A Case Report

Abstract

Background: Uterine anomalies, particularly the bicornuate uterus, pose significant risks to pregnancy outcomes, often leading to complications such as recurrent pregnancy loss, preterm birth, and cervical insufficiency. The bicornuate uterus, characterized by a partial fusion of the Müllerian ducts, represents a unique clinical challenge, particularly when pregnancy occurs in a rudimentary horn.

Objective: To report a rare case of early second-trimester rupture in a primigravida with a bicornuate uterus, discussing the diagnostic challenges and management strategies, as well as highlighting the importance of recognizing uterine malformations as a differential diagnosis in early gestation presentations.

Methods: A retrospective case review was conducted, detailing the presentation, diagnosis, and management of a 25-year-old primigravida who presented with acute abdominal pain at 14 weeks and 5 days of gestation. Clinical assessment included a thorough physical examination, sonographic imaging, and emergent laparotomy. The diagnostic process examined vital signs, abdominal conditions, and ultrasound findings, leading to surgical intervention. Preoperative and postoperative care procedures were analyzed.

Results: The patient's emergency ultrasound indicated hemoperitoneum and an empty uterine cavity, with a nearby gestational sac corresponding to a 10-week fetus. Laparotomy revealed 2.5 liters of hemorrhagic fluid and a ruptured rudimentary horn with a 4 x 2 cm rent. Postoperative recovery was uneventful, and histopathological examination confirmed the bicornuate nature of the uterus.

Conclusion: This case elucidates the critical need for vigilance and early diagnostic consideration of congenital uterine anomalies in pregnant patients presenting with non-specific abdominal pain. Effective management and improved outcomes hinge upon rapid identification and treatment of such high-risk pregnancies.