Uterus didelphys

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). 

Uterus didelphys maybe associated with alongitu-dinal (75%) or, more rarely, with a transverse vaginal septum, the latter causing obstructive hematome-trocolpos. Endometriosis as a result of retrograde menstruation may also occur in these conditions. A non-obstructive uterus didelphys is usually asymptomatic. 

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... 

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. 

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)... 

Fig. 7.4a-f. Schematic presentation of classes 111, IV, and V. a Uterus didelphys (class 111) b-d bicornuate uterus (class IV) b complete, c partial, d arcuate e,f septate uterus (class V) e complete, f partial... 

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... 

An uterus didelphys or bicornuate uterus can, therefore, readily be demonstrated. The prepubertal uterus is smaller, has a tube shape, and a non-appar-ent endometrium, making it almost impossible to evaluate uterine anomalies (Fig. 7.10). 

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