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True uterine diverticulum is an exceedingly rare entity. We report only the second case, to our knowledge, of a nulliparous uterus containing a diverticulum communicating with the endometrial cavity. True uterine diverticula probably arise from a localized duplication of the distal Müllerian duct on one side. They may be confused pathologically with uterine sacculations of pregnancy, but tend to have thicker walls. Associated conditions include "ectopic" pregnancy in the diverticulum, dysmenorrhea, and abnormal uterine bleeding.

Background: Uterine diverticula complicating pregnancy rarely are reported and should be differentiated from sacculation of pregnancy and other pelvic masses., Case: A primigravida presented for a routine second-trimester anatomical survey ultrasound examination at 22 weeks of gestation. She initially was thought to have a bicornuate, bicolic uterus with bulging membranes. However, on examination, one normal-appearing cervix was found, and no membranes were visible. Magnetic resonance imaging demonstrated a posterolateral uterine diverticulum. At 31 weeks of gestation, she had premature rupture of membranes and onset of labor. Delivery by cesarean was performed, and the presence of a uterine diverticulum was confirmed., Conclusion: Uterine diverticula are rare anomalies in the pregnant uterus and should be considered in the differential diagnosis of a fluid-filled pelvic mass. With close observation, successful pregnancy outcome can be achieved.

Primary uterine diverticula are a very rare congenital anomaly of the uterus with only 21 reported cases. Even rarer is the occurrence of primary cervical diverticula with only six cases reported so far. This is a unique case of a huge abdominopelvic mass arising from cervical fibroid around an infected cervical diverticulum. A 44 year-old, P4L4 came to the OPD with a eighteen weeks size abdomino-pelvic mass. She had a failed surgery 6 months back, attempted to remove the mass. Magnetic resonance imaging revealed a cervical diverticulum which possibly had a pus collection. Relaparotomy was done. It revealed a huge cervical fibroid with dense adhesions all around the mass. A pan hysterectomy was done. In the postoperative period, she developed high-grade fever owing to the development of a pelvic collection, which had to be drained by dilating the vault sutures. Histopathology report confirmed a cervical fibroid with an infected diverticulum within. Primary uterine or cervical diverticula are a very rare anamoly which possibly arise because of a weakness in the area where the two mullerian ducts fuse. Women with this rare condition may suffer from infertility, fever and pain abdomen, acute abdomen owing to torsion or hemoperitoneum, pregnancy complications, and menorrhagia. Diverticulectomy and cervical/uterine reconstruction can be done on nulliparous women while hysterectomy can be offered to perimenopausal women. To conclude, unless known by the gynecologists, radiologists, and the pathologists, this diagnosis can be easily missed out, leading to multiple preventable complications. [ABSTRACT FROM AUTHOR]

A primary uterine cervical diverticulum is a rare Müllerian anomaly, and clinical manifestation of this condition has not been well documented. Primary uterine diverticula are thought to arise due to unilateral distal nonfusion of the Müllerian duct and have a thick smooth muscle layer and a lumen covered with cuboidal epithelium resembling the myometrium and uterine cervical epithelia (Chufal et al. [2]). [Extracted from the article]