Congenital bladder exstrophy with uterine didelphys and prolapse of both uterine horns: a case report

Congenital pelvic anomalies include disorders of both the urinary and reproductive tracts. These disorders often coexist due to the overlapping embryological development of both systems. Magnetic resonance imaging (MRI) is a useful tool for characterization of the reproductive tract and can play an important role in the preoperative evaluation of patients with known bladder exstrophy. Accurate delineation of reproductive tract anomalies is critical as it can influence the surgical approach and can have implications for fertility. Here, we present a case of a 50-year-old female with uterine didelphys and congenital bladder exstrophy, which is an uncommon association. Our case is unique as the MR appearance of bladder exstrophy with concurrent uterine didelphys has not been reported. Additionally, this represents the first reported example of congenital herniation of both horns of the didelphys uterus through the mons pubis in the setting of bladder exstrophy. •Congenital anomalies of the urinary and reproductive tracts often coexist.•While Müllerian anomalies frequently occur with bladder exstrophy, didelphys is a rare association.•MRI is the imaging modality of choice for classifying Müllerian anomalies.•Accurate classification of Müllerian anomalies has implications for fertility and presurgical planning.