It is interesting to note that in uterus bilocularis also we sometimes find folds running from bladder to rectum and through the uterus. Axe they analogous to the ligamentum recto vesicalis? If they are, the halvomi of the womb must have united in spite of the latter, and have included it between them.
The number of positive cases of uterus didelphys is too small for us to form any correct clinical picture of the anomaly, nor can we say whether the functions of the two divided halves are also complete.
As to menstruation, it is normal. There is no alternation between the two organs, as has been seen in some cases of duplexity of the organ.
Atresia and unilateral hematometra may occur. F. Freudenberg has described a very interesting case of the kind which occurred in Schroder's clinic, and which came to the table: A hematometra lateralis with simple vagina was diagnosed in a poorly developed girl fifteen years old. Aft,er puncture the canal closed, and a new blood-tumor formed; so two years later puncture was done again, a portion of the occluding membrane excised, and the uterine united with the vaginal mucous membrane so as to form a new canal. The patient died with symptoms of peritonitis, caused by the rupture of a pyosalpinx. The autopsy showed that both uteri were completely separated, and that between them, and united to them, lay the rectum. The right uterus was dilated by blood, the cavity being .26 inches long; the left was smaller, and club-shaped; it measured 1.4 inches. The two cervices were united by a triangular plate, only their lower extremities being directly in con tact. The vagina was simple. There were numerous perimetric adhe sions.
Lebedew's case ran a more favorable course. One half of the genital canal was closed by a hymeneal atresia, and hEematometra lateralis devel oped.
The patient was a teacher, twenty-one years old, and had amenorrhcea and abdominal pains. These pains retunaed every three weeks, and be came specially severe after October, 1880. From March, 1881, they were constant, and accompanied by diarrhcea.
When examined under chloroform, rectal touch revealed a fluctuating tumor filling the vagina, and divided above the small pelvis into two lateral masses. Division of hymen with.outflow of tar-like blood; intro duction of rubber tube; cessation of hemorrhage on the third day.
Subsequent examination showed complete division of the vagina to within half an inch of the hymen, double portio vaginalis, and completely divided utenne cornua. The sound showed the right horn to be four,
and the left to be four and a halt inches long.
C. Staude's case, in which the right uterus as well as the vagina was filled with blood, is interesting. The retention tumor displaced the empty uterus to the left, without, however, disturbing the shape of the vaginal portion. It was supposed to be a cervical tumor, and was punc tured after the laparotomy. After the diagnosis was made the puncture was closed, and a vaginal communication established. The patient re covered, but auccumbed six months later to an intercurrent affection.
The illustration shows very plainly that the case was one of uterus didel phys.
Conception is not interfered with if the vagina is not (as in Tauffer's case) rudimentary, and unfit for cohabitation. A case is recorded by Satschowa in which both cavities were gravid.
The woman, twenty-six years old, had aborted once, had one year before borne a child at term, and was now again three months pregnant She consulted Satschowa for a violent hemorrhage. The first examination revealed only a vagina and a two-months' pregnant and aborting uterus. Only after the woman herself had drawn his attention to the abnormal structure of her sexual organs (she had been told by a former physician of hers) vras the following found: external genitals normal; .4 inch from introitus begins a complete vaginal septum; two complete uteri, both gravid; the left containing a one and a half months'aud the right a three months' fcetus.
Satschowa believed that he found a certain case of super-fcetation, but the two fceti were not described sufficiently in detail for us to decide.
Childbirth at term does not seem to differ from that of the uterus bi cornis, as the following case of F. Benicke will show: The uterus lay in the middle of the abdomen; but there was no aign of bicernity about the fundus. The introitus was divided by a septum into a wide left and a smaller right opening, and the vagina into two canals, of which the left was the wider. In the left vaginal vault the os was completely dilated, and the bead could be felt; in the right was a swollen and relaxed portio with closed opening. The body of the closed uterus could not be felt; the sound passed backwards 4.4 inches. Labor was ended with the forceps.