title: Challenging Case of Postmenopausal Bleeding and Complete Urogenital Duplication.
abstract: BACKGROUND
  Müllerian duct anomalies represent a wide spectrum of congenital abnormalities ranging from simple uterine anomalies to more complex multisystem derangements. Complete duplication of uterus, cervix, and vagina may be associated with urologic and caudal gastrointestinal malformations.
  
  
  METHODS
  We present a case report detailing the management of a morbidly obese patient with postmenopausal bleeding and thickened endometrial stripe who had a very rare condition of pelvic organ duplication, including 2 hemiuteri, 2 vaginas, 2 hemibladders, and 2 each of ovaries, fallopian tubes, kidneys, and ureters. Laparoscopic hysterectomy was complicated by difficulties understanding urinary system anatomy requiring intraoperative urology consultation and imaging.
  
  
  CONCLUSIONS
  Management of patients with urogenital duplication and abnormal uterine bleeding requires a thorough understanding of possible associated malformations. Thorough preoperative evaluation, careful surgical exploration, and multidisciplinary approach may be necessary to avoid urologic injury in such patients.
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Olga
authors.initials: O
authors.lastname: Grechukhina
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Diana P
authors.initials: DP
authors.lastname: English
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Devin
authors.initials: D
authors.lastname: Miller
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Ratner
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications; D017698:Postmenopause; D014564:Urogenital Abnormalities / Q000175:diagnosis*; D014592:Uterine Hemorrhage / Q000209:etiology*