Didelphys Uterus (HSG)

Uterus Didelphys (Hysterosalpingography)

Uterus didelphys is a congenital Müllerian duct anomaly caused by complete failure of fusion of the paired Müllerian ducts. This results in two entirely separate uterine cavities, each with its own cervix, and often an associated longitudinal vaginal septum. On hysterosalpingography, two distinct and widely separated uterine cavities are demonstrated, each filling independently with contrast (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram showing uterus didelphys. Two completely separate uterine cavities are visualized with wide lateral separation (arrows). Each cavity fills independently with contrast.

Findings: Two well-formed uterine cavities are seen with smooth margins and wide intercornual separation. Each cavity typically has its own cervix. Fallopian tubes may be seen arising from each uterus with variable tubal patency.

Conclusion: Hysterosalpingographic features are consistent with uterus didelphys.

Patient Symptoms

Many patients are asymptomatic. Others may present with infertility, recurrent pregnancy loss, preterm labor, malpresentation, or dyspareunia due to an associated vaginal septum.

Procedure (Hysterosalpingography)

The examination is performed during the early proliferative phase of the menstrual cycle. A cervical cannula or balloon catheter is inserted into one cervix at a time. Water-soluble contrast is injected under fluoroscopic guidance to assess uterine anatomy and tubal patency.

Contrast Medium & Administration

A water-soluble iodinated contrast agent such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. The patient is positioned in the lithotomy position. Approximately 8–12 mL of contrast may be required, injected separately into each uterine cavity if both cervices are cannulated.

Instruments Used

• Sterile vaginal speculum (Cusco’s or Sims’)
• Uterine tenaculum (if required)
• Leech–Wilkinson cannula
• Rubin cannula
• Balloon HSG catheter
• 10–20 mL sterile Luer-lock syringe
• Sterile connecting tubing
• Antiseptic solution
• Fluoroscopy unit

Safety Considerations

Care must be taken to identify and cannulate the correct cervix or both cervices when present. Gentle contrast injection reduces the risk of intravasation. Pregnancy and active pelvic infection must be excluded.

Related Conditions

Differential diagnoses include bicornuate uterus and septate uterus. MRI or 3D ultrasound is useful for confirming complete uterine duplication and assessing associated renal anomalies.

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Declaration

This case is presented for academic and educational purposes only. Patient confidentiality has been preserved and no identifiable information is disclosed.