Rare urogenital anomaly causing discharge and pain. A case report

Patients with müllerian anomalies usually seek help because of poor reproductive performance.

A 16-year-old, white woman presented with a persistent, brown vaginal discharge and right lower quadrant pain. Because of voluntary guarding, the uterus could not be palpated on bimanual examination. However, transvaginal sonography showed a right cystic mass and a slightly binodular contour of the uterus. Laparoscopic evaluation revealed the presence of a bicornuate uterus. A hysterosalpingogram showed a double uterine cavity and cervical canal below the right uterine cavity, leading to a cystic, paravaginal mass. Incision of the mass and drainage of its chocolate-brown fluid content revealed a small, blind vagina leading to a second cervix. Using a wire probe, an isthmic communication was demonstrated between the two uterine cavities, leading to the final diagnosis of bicornuate uterus, laterally communicating, with a double cervix and vagina, unilaterally blind.

Awareness of the possibility of this clinically puzzling anomaly will avoid delayed or unnecessary surgical treatment.