Double Bubble in the Pelvis: A Sign of Hydrometrocolpos in Uterus Didelphys

An abdominal radiograph of a 6-day-old female with common cloaca showed dilated bowel loops and two large air-fluid levels in the pelvis [Figure 1]. One of the air-fluid levels occupied more than half of the abdomen, giving an impression of a pouch colon. Exploratory laparotomy showed uterus didelphys with huge hydrometrocolpos, occupying more than half of the abdominal cavity and filled with fecal fluid [Figure 2]. Bilateral hydroureteronephrosis was present.Figure 1: X-ray of the abdomen showing a double-bubble sign in the pelvisFigure 2: Uterus didelphys with huge hydrometrocolpos (U); Colon (C); Bladder (B)This is the first reported case of common cloaca where a double bubble was seen in the pelvis due to hydrometrocolpos in the uterus didelphys. Double air-fluid level in the pelvis has been seen in type 5 pouch colon, which is a rare entity.[1] Therefore, a double bubble sign in the pelvis of a common cloaca patient may suggest hydrometrocolpos in the uterus didelphys or type 5 pouch colon. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.