title: A rare case of first-trimester ruptured bicornuate uterus in a primigravida.
abstract: BACKGROUND
  Bicornuate uterus (BU) is a rare uterine anomaly result from incomplete fusion of the two Müllerian ducts during embryogenesis. BU very rarely can lead to rupture of the uterus during the early pregnancy with high mortality and morbidity rates.
  
  
  METHODS
  A primigravida in the first trimester (9 weeks) presented complaining of epigastric pain and vomiting for one day. Ultrasound scan was performed at the 7th week of pregnancy and showed a BU with single intrauterine gestational sac in the right horn. On presentation, the patient was pale and irritable. Urgent ultrasound scan showed viable fetus in the right horn, free fluids in Morrison's pouch. Laparotomy showed BU with pregnancy in the ruptured right horn. The defect in the uterus was repaired. Postoperatively, the patient was advised to use contraceptive pills for one year.
  
  
  CONCLUSIONS
  Our patient has a sonographic diagnosis of BU at the 7th gestational week. At that stage, nothing was done except close follow up of the pregnancy. When she developed severe epigastric pain, initially, we thought of peptic ulcer disease complications. Even after deterioration of the patients' condition, the diagnosis was not clear as the urgent ultrasound showed a viable fetus. Blood and fluid replacement therapy, and exploratory laparotomy were essential to save the patient's life.
  
  
  CONCLUSIONS
  This case highlights the fact that uterine rupture can occur in early pregnancy when associated with uterine anomaly. Early sonographic diagnosis has a major contribution in evaluation and management.
authors.affiliation: Department of Surgery, Al Rahba Hospital, Abu Dhabi, United Arab Emirates. Electronic address: ahefny@uaeu.ac.ae.
authors.forename: Ashraf F
authors.initials: AF
authors.lastname: Hefny
authors.affiliation: Department of Radiology, Al Rahba Hospital, Abu Dhabi, United Arab Emirates.
authors.forename: Fathima T
authors.initials: FT
authors.lastname: Kunhivalappil
authors.affiliation: Department of Obstetrics and Gynaecology, Al Rahba Hospital, Abu Dhabi, United Arab Emirates.
authors.forename: Ritu
authors.initials: R
authors.lastname: Nambiar
authors.affiliation: Department of Surgery, Al Rahba Hospital, Abu Dhabi, United Arab Emirates.
authors.forename: Masoud O
authors.initials: MO
authors.lastname: Bashir
keywords: Bicornuate uterus; Pregnancy; Rupture