Spontaneous rupture of bicornuate uterus in second trimester: A case report

The bicornuate uterus is a rare congenital anomaly of the uterus. Complete uterine rupture in the first or second trimester associated with a bicornuate uterus is an infrequent and life-threatening presentation. Due to its rarity, the diagnosis is often overlooked, leading to potentially fatal outcomes.

Here, we report a rare case of spontaneous complete rupture of the right horn of a bicornuate uterus in a 32-year-old woman at 20 weeks of gestation, who presented with abdominal pain and vomiting. On evaluation, rebound tenderness and guarding were present mimicking conditions such as acute appendicitis or ruptured ectopic pregnancy. On ultrasonographic evaluation, hemoperitoneum was suspected and a diagnosis of complete uterine rupture was made intraoperatively and managed by excision of the gravid rudimentary horn.

At an early gestation, uterine rupture usually presents with a nonspecific clinical presentation; making its diagnosis more difficult. However, not all cases present these features; thus, it is essential to maintain a high degree of suspicion. This case highlights the importance of early recognition of uterine anomalies like bicornuate uterus to prevent life-threatening complications such as uterine rupture.

Uterine rupture should be considered in pregnant women presenting with acute abdominal pain, hypovolemia, hemoperitonium, even in early pregnancy. Prompt surgical intervention is crucial to prevent maternal mortality. The objective of this case report is to raise clinical awareness about the possibility of spontaneous uterine rupture in early pregnancy, particularly in women with undiagnosed uterine anomalies.