Background: Uterine rupture is a rare but catastrophic obstetric emergency, most commonly associated with previous uterine surgery. Spontaneous rupture in an unscarred uterus is exceptionally uncommon, particularly in association with Müllerian anomalies such as uterus didelphys. These anomalies significantly increase maternal and fetal morbidity due to delayed diagnosis and atypical clinical presentation.

Case Presentation: We report a case of a 27-year-old primigravida with six months of amenorrhea who presented with sudden onset abdominal pain of two days’ duration, associated with vomiting. During clinical examination, the patient collapsed and required immediate cardiopulmonary resuscitation. Emergency bedside ultrasonography revealed moderate hemoperitoneum with uterine rupture. The patient underwent emergency exploratory laparotomy, which revealed uterus didelphys with rupture of the right uterine horn extending from the cornual end to the upper cervix. Approximately 1500 mL hemoperitoneum was evacuated. A dead male fetus weighing 378 g was delivered, and excision of the ruptured horn was performed. The postoperative course was uneventful following intensive care management.

Conclusion: Spontaneous rupture of a gravid horn in uterus didelphys during the second trimester is exceedingly rare and often presents as a diagnostic challenge. Early recognition, rapid resuscitation, and prompt surgical intervention are critical to maternal survival.

Keywords: Hemoperitoneum; Müllerian anomaly; Second trimester; Uterus didelphys; Uterine rupture

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Dr Disha Vishwanath

Junior Resident, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore