Postmenopausal Bleeding With a Diadelphic Uterus

A recent report describes a case of a 59-year-old, P1L1, Previous LSCS with a diadelphic uterus with longitudinal vaginal septum who complained of postmenopausal bleeding. 

Her MRI revealed endometrial hyperplasia in both uteri with no obvious myometrial infiltration. She was scheduled for hysterectomy frozen section and proceeded SOS to staging laparotomy in view of recurrent postmenopausal bleeding and morbid obesity. The patient underwent total abdominal hysterectomy with bilateral salphingophorectomy with frozen section. 

During surgery, the bladder appeared adherent to the previous c-section scar on the left horn. Hence, the patient underwent a left sub-total hysterectomy, followed by a right total hysterectomy. Both cervices were also delivered. 

The frozen section showed simple hyperplasia without atypia in the left horn and hyperplasia with foci of intraepithelial neoplasia in the right horn, which was confirmed in histopathology.

This report underscores the importance of knowing any potential related deformities when managing patients with Mullerian defects and irregular uterine hemorrhage. 

Gynecologists must perform a thorough preoperative evaluation, meticulous surgical investigation, and multidisciplinary approach to prevent urological problems and surgical mishaps.

Choudhari A, Senthil Kumar AC, Shankar K, Postmenopausal bleeding with a diadelphic uterus: A case report. Indian J Obstet Gynecol Res 2023;10(3):366-370