Duplicated uterus

Fig. 12.9a-c. Uterus didelphys. T2-weighted images in transverse and coronal orientation. Good visualization of the duplicated uterus (a) and the two fluid-filled vaginas (b,c)... 

Unilateral obstructive vaginal septum. In some cases of duplicated uterus with a midline vaginal septum the caudal end of one hemivagina, more often the left, is obstructed (uterus didelphys with septate... 

Apart from the classic pattern in which the uterine artery arises from the medial aspect of llA, there are many other variants that have been identified (please see Chap. 10.3). It may also arise from its anterior or lateral aspect of the IIA [18]. The origin of the uterine artery from the main IIA itself or from the aorta has also been described [18]. A common trunk between the uterine artery and vesical artery is another important variant that might lead to inadvertent vesical ischemia in cases of non-tar-geted embolization [19]. The uterine artery may also duplicate as illustrated by Redlich et al. [20]. The ovarian artery represents the second main vessel for PPH [21, 22]. The ovarian artery that participates in uterine blood supply could represent the major feeding vessel to the uterus as demonstrated in UFE literature [23] (Fig. 9.2). Recently, Saraiya et al. illustrated uterine artery replacement by the round ligament artery during embolization for leio-... 

Definition Uterus didelphys as a result of complete non-fusion of the Mullerian ducts forming a complete uterine duplication with no communication between each other [23,26,27] (Fig. 4.4). 

Fig. 4.4a,b. A 33-year-old female patient with a history of partially resected longitudinal vaginal septum. Transverse oblique T2-weighted MR images (a) show complete duplication of the uterine horns (arrows), as well as two duplicated cervices (arrowheads). The cavities show their normal zonal anatomy. Note the longitudinal vaginal septum (b) which appears in 75% of uterus didelphys... 

Bicornuate uterus occurs with wide variability. Extension of the intervening fundal cleft to the internal cervical os characterizes the complete bicornuate uterus with a single cervix (bicornuate, unicollis uterus), whereas variants of partial bicornuate uterus exist if the cleft is of variable length. Bicornuate uterus maybe associated with a duplicated cervix (bicornuate bicollis uterus), as well as with a longitudinal... 

A longitudinal vaginal septum (Fig. 12.9) occurs as a consequence of incomplete fusion of the miille-rian ducts or resorption failure of the vaginal septum. This anomaly is also typically associated with other malformations of the mullerian ducts [septate uterus, bicornuate uterus, uterus didelphys (Fig. 12.9), cervical duplication] [2j. 

Another causal factor in enuresis nocturna might be rapid bladder Ailing (N0rgaard et al. 1989). In this context the rare anatomic abnormality of a completely duplicated ureteral system in which an ectopic ureter empties directly outside the bladder has to be kept in mind. In this case the upper renal moiety drains through a ureter that empties below the urethral sphincter or at some other ectopic site such as the vagina, uterus or even the perineum. Hence, these children are wet all of the time. This condition occurs exclusively in girls. 

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