Abstract

Bicornuate uterus is due to incomplete fusion of Mullerian ducts at the level of uterine fundus. In this condition lower uterine segment as well as cervix is fused thereby resulting into 2 separate but communicating endometrial cavities. Although majority of the patients having bicornuate uterus remain relatively asymptomatic some women may present with recurrent abortions. Tubectomy in patients with bicornuate uterus may pose a peculiar dilemma for operating surgeon. In cases of bicornuate uterus sometimes only one fallopian tube is found then the possibility of bicornuate uterus must be kept in mind. Failure to do so may result in future pregnancy thereby putting the surgeon at the risk of unnecessary litigations. We hereby present this case of a 35-year-old female patient having 8 weeks pregnancy and was willing for medical termination of pregnancy and tubal ligation. During tubectomy tracing of right cornual structure led to another cornue of uterus and fallopian tube with right fallopian tube and right ovary. Right fallopian tube was caught with babcock forceps and tubectomy was carried out by modified pomeroys method. Left fallopian tube was also ligated. This case highlights the need to bear in mind the possibility of bicornuate uterus in cases posted for tubectomy who were found to have only 1 fallopian tube during surgical procedure. All such patients should be explored under general anaesthesia and if such facilities are not available (for example at primary health care centre level) then same should be clearly explained to the patient and also should be documented on case paper as well as discharge card and in that case patient must be advised about continuation of alternative contraceptive methods. We hereby report a case of 35-year-old with 10 weeks pregnancy who underwent medical termination of pregnancy. There was past history of tubal ligation in the patient and indication for medical termination of pregnancy was contraceptive failure. During tubectomy she was found to have bicornuate uterus. Left fallopian tube was found to be ligated. Tubectomy on right side was done by modified pomeroys method.

Keywords: Mullerian duct anomalies, Bicornuate uterus, Tubectomy, Modified Pomeroys method.