Rupture of right non-communicating horn of bicornuate uterus with twin pregnancy

The rupture of uterus in first and second trimester is very rare and mostly associated with uterine anomalies or cornual pregnancy. Bicornuate uterus (BU) is a uterine anomaly results from incomplete fusion of the two Mullerian ducts during embryogenesis. Here we are presenting a case of primigravida in the second trimester (20 weeks) as ruptured ectopic pregnancy in emergency. Laparotomy showed BU with twin pregnancy in the ruptured non communicating right horn. Right horn excision was done. This case highlights the twin pregnancy in non-communicating horn of uterus and its rupture in early pregnancy. Cases with non-communicating horn are reported but twin pregnancy in noncommunicating horn is a rare one. In asymptomatic women, the presence of bicornuate uterus may not be detected until during pregnancy or delivery. In case of pregnancy in rudimentary horn, early sonographic diagnosis has a major contribution in evaluation and management. Treatment usually involved is resection of the ruptured horn. Since the scar is present on the uterus, it is important to avoid pregnancy for at least 1 year.