Pregnancy in a patient with complete double uterus

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Menses began at eleven years; the patient had had marked dysmenorrhea starting three days before each period and lasting until three days after the period was over. In 1929, when fifteen years old, she had several attacks of acute abdominal pain, usually starting on one side and crossing to the opposite side. There was no vomiting; the attacks lasted for about twenty-four hours and disappeared. There was. however, during this time an almost constant dull pain in the right side, which frequently became sharp -xhen rising from a sitting position. After an acute attack in July of this year, the patient was sent to the hospital and an appendectomy and right oophorectomy were performed. The pathologic 1abora;ory report states that the appendix was enlarged, with obliterated lumen, densely fibrotic walls, atrophied muscle and obliterated glands. The right ovary consisted mainly of a large luteal cyst filled with hyaloid material; the cyst walls and cortex were thin and sclerotic. A diagnosis of obliterative appendicitis and luteal cystic ovary was made and the patient was discharged on the seventeenth day in good general condition. The family was informed at this time that the girl’s genital organs were abnormal. In 1932, the patient came to the gynecological clinic for treatment of the dysmenorrhea which for the past three or four months had become increasingly severe and necessitated remaining in bed for several days of each month. The pain started just above the symphysis and radiated chiefly to the left side, left loin, and down t.he left leg. On physical examination the patient appeared to be a perfectly normal seventeenyear-old white female, but pelvic examination revealed a double introitus and llouble vagina, each side .aith a small buttonlike cervix. The uterus could not be easily palpated because of abdominal rigidity. The adnexa were not palpable. Dilatation of both cervices was advised as a palliative measure, and this was done May 3, 1932. At o,peration, a Rubin test showed the left tube patent at a pressure of 80 millimeters of mercury. The right tube was not patent. At attempt at lipiodol injection and x-ray was unsuccessful. The vaginal septum was removed at the request of the mother. After the operation there was partial relief from dysmenorrhea for several months, then the patient married as.d moved to another state. In a short time it was reported that the dysmenorrhea was becoming progressively more severe. On one occasion the patient became comatose just before onset of menses. At this point cervical dilatation was again resorted to and several of the subsequent periods were acco~npanied by greatly diminished dysmenorrhea.