Müllerian duct anomalies and uterine leiomyomas represent distinctive facets of female reproductive health. While uterine leiomyomas are prevalent reproductive pathologies, the coexistence of Müllerian anomalies and leiomyomas is relatively uncommon. This case study examines the complex medical and surgical management of a woman who initially presented with chronic abdominal pain and swelling. Following evaluation, the patient received a diagnosis of an uncommon co-occurrence of congenital uterus didelphys and leiomyomas. Notably, during the surgical procedure, a rectovesical peritoneal band was identified. This case study seeks to broaden the scientific understanding of these subsets of women, offering insights into the complexities arising from a common diagnosis overlaying a rare condition.