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A Snake With 2 Heads? Pitfalls in Diagnosis and Management of Uterus Didelphys With Obstructed Hemivaginae

Susana Rey-Alvarez, MD, MPH
Arch Pediatr Adolesc Med. 1997;151(6):631-632. doi:10.1001/archpedi.1997.02170430097022.
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A 12-year-old girl with abnormal vaginal discharge was found to have uterus didelphys with unilateral imperforate vagina and ipsilateral agenesis of the kidney. This constellation of congenital malformations is often asymptomatic until puberty, when it presents as cyclic dysmenorrhea, leukorrhea, or a pelvic mass. Evaluative workup should begin with a careful medical history, pelvic and rectal examinations, and pelvic ultrasound scan. Gynecologic consultation for vaginoscopy, vaginal ultrasonography, and laparoscopy will usually be necessary. Magnetic resonance imaging is becoming the preferred modality for delineation of uterine malformation. When congenital abnormalities of the reproductive tract are encountered, a search should also be made for renal anomalies.

Patients with uterus didelphys, including our patient, often are seen with pain severe enough to mimic the acute abdomen. They undergo inappropriate surgical procedures, including the removal of functional reproductive organs. They also may not receive a true diagnosis until a pregnancy becomes unexpectedly complicated. It


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