Successful Treatment of Hematopyometra in One Horn of a Didelphys Uterus While Maintaining a Viable Pregnancy in the Other Horn

Congenital uterine anomalies are rare, with didelphys uterus being one of the least common. Although generally asymptomatic, it can be associated with infertility, dysmenorrhea, and various pregnancy complications including spontaneous abortion and preterm delivery. We present the case of a 29-year-old gravida one para zero female at 6 weeks and 4 days gestational age who presented with pelvic pain during pregnancy. She was incidentally found to have a didelphys uterus during evaluation. She was diagnosed with a hematopyometra in the right horn, likely the cause of her pelvic pain, while carrying a viable pregnancy in the left horn. She was successfully treated with antibiotics and hysteroscopy with dilation and curettage. The remainder of her pregnancy was relatively uncomplicated until delivery and her postpartum course was uneventful. This case demonstrates a rare but possible pregnancy complication in a patient with didelphys uterus as well as successful management of that complication in pregnancy.