Uterus didelphys is a type of Müllerian duct anomaly (class III) where there is complete duplication of uterine horns as well as duplication of the cervix, with no communication between them.
Didelphic uteri account for approximately ~8% (range 5-11%) of Müllerian duct anomalies.
Many patients are asymptomatic although some may occasionally experience dyspareunia as a result of the vaginal septum.
It results from failed ductal fusion that occurs between the 12th and 16th week of pregnancy and is characterised by two symmetric, widely divergent uterine horns and two cervices. The uterine volume in each duplicated segment is reduced. As with most uterine anatomical anomalies, there is an increased incidence of fertility issues, and Müllerian abnormalities in general are over represented in infertile women. The chance of seeing a pregnancy to term is significantly reduced, down to only 20%, with a third of pregnancies ending in abortion and over half in premature deliveries. Only 40% of pregnancies resulted in living children 2.
Along with unicornuate uterus, uterus didelphys has the greatest impact on reproductive performance reference required.
- renal agenesis
vaginal septum which can include a transverse vaginal septum
- there is a vaginal septum in 75% of cases, and obstruction to one horn is possible from occasional transverse septae.
Classically shows two widely spaced uterine corpora, each with a single Fallopian tube. Separate divergent uterine horns with large fundal cleft (as distinct from a septate uterus)
HSG demonstrates two separate endocervical canals that open into separate fusiform endometrial cavities, with no communication between the two horns. Each endometrial cavity ends in a solitary fallopian tube.
If the anomaly is associated with an obstructed longitudinal vaginal septum, only one cervical os may be depicted, and it may be cannulated with the endometrial configuration mimicking a unicornuate uterus.
Separate divergent uterine horns are identified with a large fundal cleft. Endometrial cavities are uniformly separate, with no evidence of communication. Two separate cervices need to be documented.
MR imaging demonstrates two separate uteri with widely divergent apices, two separate cervices, and usually an upper vaginal longitudinal septum. In each uterus, normal uterine zonal anatomy is preserved.
Abdominal and pelvic anatomy
- skeleton of the abdomen and pelvis
- muscles of the abdomen and pelvis
- anterior abdominal wall (surface anatomy)
- posterior abdominal wall
- pelvic floor
- spaces of the abdomen and pelvis
- posterior abdominal wall
- peritoneal ligaments
- right supramesocolic space
- left supramesocolic space
- inframesocolic space
- supramesocolic space
- inguinal canal (mnemonic)
- Hesselbach triangle
- scrotal sac
- pelvic cavity
- abdominal and pelvic viscera
- gastro-oesophageal junction
- small intestine
- large intestine
- anal canal
- biliary tree
- adrenal gland
- organs of Zuckerkandl
- renal pelvis
- renal sinus
- avascular plane of Brodel
- urinary bladder
- male reproductive system
female reproductive system
- Mullerian duct
- uterine tubes
- variant anatomy
- gastrointestinal tract
- blood supply of the abdomen and pelvis
- inferior phrenic artery
- coeliac artery
- superior mesenteric artery
- middle suprarenal artery
- renal artery (variant anatomy)
- gonadal artery (ovarian artery | testicular artery)
- inferior mesenteric artery
common iliac artery
- external iliac artery
internal iliac artery (mnemonic)
- anterior division
- posterior division (mnemonic)
- variant anatomy
- abdominal aorta
- portal venous system
inferior vena cava
- hepatic veins
- renal vein
- common iliac vein
- variant caval anatomy
- inferior vena cava
- innvervation of the abdomen and pelvis
- 1. Carrington BM, Hricak H, Nuruddin RN et-al. Müllerian duct anomalies: MR imaging evaluation. Radiology. 1990;176 (3): 715-20. Radiology (abstract) - Pubmed citation
- 2. Raga F, Bauset C, Remohi J et-al. Reproductive impact of congenital Müllerian anomalies. Hum. Reprod. 1997;12 (10): 2277-81. doi:10.1093/humrep/12.10.2277 - Pubmed citation
- 3. Steinkeler JA, Woodfield CA, Lazarus E et-al. Female infertility: a systematic approach to radiologic imaging and diagnosis. Radiographics. 29 (5): 1353-70. doi:10.1148/rg.295095047 - Pubmed citation
- 4. Eurorad teaching files : Case 687
- 5. Eurorad teaching files : Case 7773
- 6. Eurorad teaching files : Case 2309 - uterus didelphys with an imperforate vaginal septum
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Double uterus with double cervix||✗|