Congenital anomalies of the female genital tract arise from dailure of formation, fusion or resorption of the Mullerian ducts and are associated with a wide array of gynaecological and obstetric diseases. This case series illustrates three unique uterine anomalies. The first case is of a 16-year old girl presenting with complaints of primary amenorrhea. On examination, the vagina ended in a blind pouch and pelvic ultrasonography revealed absence of the uterus and MRKH syndrome was diagnosed. Diagnostic laparotomy was considered and pre-operative x-ray revealed an underlying Scimitar Syndrome, a form of anomalous pulmonary venous return. Bilateral ovaries were healthy, and surrogacy, ovum donation and vaginoplasty was advised. The second case is of a 30-year old G2P1 woman at 14 weeks of gestation presenting with acute abdominal pain. Ultrasonography showed hemoperitoneum and an emergency laparotomy was carried out revealing a ruptured, non-communicating horn of a unicornuate uterus containing the fetus within the amniotic sac. The horn was excised. The third case is of a 20-year old P1L1 woman with suspicions of uterine didelphys, raised during her previous c-section. Diagnostic hysteroscopy was performed revealing a non-communicating horn of unicornuate uterus. The rudimentary horn was excised in the interval period. This case series underscores the complexity in diagnosing and managing Mullerian anomalies, particularly in syndromic associations, such as MRKH co-existing with Scimitar Syndrome – the occurrence of which is exceptionally uncommon: and to the best of our knowledge, the first recorded case in literature. Early imaging, multidisciplinary evaluation and timely interventions – essentially in cases involving rudimentary horns – are essential to prevent morbidity and optimize reproductive and long-term outomces.

Aarnav Pathak is undergoing his MBBS degree in Shri Atal Bihari Vajpayee Medical College & Research Institute since 2023. During his tenure, he has overseen over 10 research papers and the national level. He is currently the undersecretary of science & research at his institute and was the youngest research mentor at a national research convention in Stanley Medical College. His academic achievements involved being the institutional topper in all 3 subjects if his second year and receiving research grants from multiple organizations.