Twin pregnancy in an accessory cavitated non-communicating uterus

• Obtaining a detailed medical history is important, and we should not depend on examination tools when dealing with patients.
• Unexplained findings should raise suspicions regarding other possible diagnoses, and the same non-conclusive procedures should not be repeated.
• Following this advice can prevent unnecessary operative procedures and the complication of perforation of the uterus.

BackgroundA uterine malformation is a type of female genital malformation resulting from abnormal development of the Mullerian duct(s) during embryogenesis. The type and degree of uterine malformation depends on the level at which the fusion process of the two Mullerian ducts stops; thus, there is a wide variety of malformations. A newly described deformity called accessory cavitated uterine mass (ACUM) has been increasingly reported.The caseWe report this deformity (in a 20-year-old married woman) which appears to be an additional incompletely developed, cavitated and presumably non-communicating uterus in addition to a normally shaped and developed uterus. The former uterus became impregnated with twins that died in a missed abortion at 13 weeks of gestation. Before discovering the presence of the deformity, three attempts were made to evacuate the dead fetuses by cervical dilatation and curettage of the normal empty uterus. These attempts resulted in perforation of its fundus, a laparotomy was performed to repair the uterus. During the laparotomy, the pregnant accessory uterus was discovered and was excised with the dead twins.DiscussionThe lack of good medical history was a cause of the mismanagement of this patient. Most probably, the origin of ACUM is a growth from the right Mullerian duct. The ovum has entered the ACUM through the rudimentary tube and has been fertilized by a sperm travelled either through the normal vaginal and uterine cavities or through the lymphatics.Conclusions(1) A detailed case history is important. (2) An ACUM can be impregnated.