Uterus Didelphys, a Rare Cause for Tubal Sterilization Failure

EDITORIAL COMMENT: : We accepted this case report for publication because uterus didelphys and its often‐associated longitudinal vaginal septum can cause a variety of complications in the practice of obstetrics and gynaecology. When performing tubal ligation the surgeon would search for the second Fallopian tube and presumably could, as suggested in this paper, misdiagnose one half of the didelphys as a unicomuate uterus. The fold of peritoneum between bladder and sigmoid colon could obscure the other uterine horn. When the editor was a resident with Lance Townsend at The Royal Women's Hospital, Melbourne, in the 1950's, when abortion by the medical profession was not readily available, we had to cope with a patient with an unwanted pregnancy in one horn of her uterus didelphys, a condition unknown to her doctors when they had inserted a Grafenberg ring into the other horn for contraception. The vaginal septum can lead to diagnosis by causing dyspareunia and obstructed labour. The editor has also diagnosed the condition when performing a Manchester repair in a postmenopausal woman. In this case it was not until the cervix was amputated that the laterally‐displaced vaginal septum and the second cervix it had hidden from view, was first recognized. This woman had used one half of her vaginal and uterine complement for coitus, conception and delivery of her children without symptoms due to extreme lateral displacement of the vaginal septum. See also Editorial Comment. Uterus didelphys with unilateral imperforate vagina and ipsilateral renal agensis. Aust NZ J Obstet Gynaecol 1991; 31: 288. Summary: Uterus didelphys is a rare congenital anomaly. It can result in a variety of misadventures even in the hands of an expert. The present case reports uterus didelphys as the cause for tubal sterilization failure. This is the first case of this type seen in our institution in 35 years.