First-trimester rupture of a gravid bicornuate uterus after prior vaginal deliveries, simulating a ruptured ectopic pregnancy: a case report

The first-trimester rupture of a bicornuate uterus (BU) is a rare obstetrical emergency, especially following previous normal vaginal deliveries where it is often misdiagnosed. A 24-year-old G(3)P(2)002 woman presented at 11 weeks of gestation with sudden onset of severe left iliac fossa pain without other symptoms. On examination, she was fully conscious and hemodynamically unstable with signs of peritoneal irritation, a distended pouch of Douglas and a slightly enlarged uterus and a tender left adnexal mass. The diagnosis of a ruptured ectopic pregnancy was made and a laparotomy was done. Intra-operative findings were hemoperitoneum, a left ruptured BU and a dead fetus. Surgical management entailed hysterorrarphy, left salpingectomy and conservation of both ovaries. Her postoperative course was uneventful and future fertility was preserved. We recommend a high index of suspicion of ruptured BU as a differential diagnosis of acute abdomen in the first trimester in women with previous term vaginal deliveries.