A bicornuate uterus, resulting from incomplete fusion of the Müllerian ducts, is a rare anomaly with a prevalence of about 0.4% in the general population. While commonly associated with adverse pregnancy outcomes such as miscarriage, preterm labor, and malpresentation, rupture of a bicornuate uterus is exceptionally rare. As a life‑threatening obstetric emergency, its recognition is often delayed or misdiagnosed, particularly in women with prior normal vaginal deliveries where typical risk factors are absent. This diagnostic challenge underscores the need for heightened clinical suspicion when evaluating abdominal pain and bleeding in pregnancy. We report a case of left-sided uterine rupture in a bicornuate uterus during the second trimester in a pregnant woman with a history of two prior vaginal deliveries. The patient presented with abdominal pain radiating to the back. On examination, the patient was conscious but hemodynamically unstable, with slight abdominal distension and tenderness, a prominent rectouterine pouch (Douglas pouch) and left adnexal tenderness. A suspected ectopic pregnancy was diagnosed, and an exploratory laparotomy was performed. Surgical findings revealed a left uterine rupture in a bicornuate uterus with a 17-week-old fetus.
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