A didelphic uterus results from fusion failure of müllerian duct caudal segments. In complete didelphys each uterine cavity has a separate cervix and a variable septum is present in the vagina. Some women
also have associated renal agenesis, dysplasia, or hypoplasia, and an ectopic ureter to Gartner’s duct cysts. A duplicated uterus can be occluded unilaterally. Girls with unilateral occlusion of a duplicated uterus develop hydrocolpos, hydrometrocolpos, hematometrocolpos, and hematosalpinx.
During hysterosalpingography uterus didelphys is confused with a unicornuate uterus if only one of the uterine cavities is injected with contrast. Magnetic resonance imaging is the examination of choice in defining these abnormalities and providing preoperative guidance. It should be noted that a congenital anomaly of cloacal exstrophy is also associated with two vaginas and hemiuteri.

Classification of common uterine anomalies. A: Uterus didelphys. B: Bicornuate uterus. C: Septate uterus. The septum consists mostly of fibrotic tissue.

Uterus didelphys. Two uterine cavities are evident. The patient had a previous vaginal septum resected
Uterus didelphys with obstructed hemivagina. A: Transverse T2-weighted MRI identifies two uteri (arrows), two cervices,
and both ovaries (arrowheads.] B: Coronal T2-weighted image shows a hematocele (arrows) due to an obstructed right hemivagina.
Didelphys in a 13-year-old. Right uterus (arrow) is hypointense due to blood and left uterus (arrowhead) hyperintense
due to fluid and secretions
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