Síndrome de Herlyn-Werner-Wunderlich: reporte de caso y revisión de la literatura

Herlyn-Werner-Wunderlich Syndrome Presenting as an Incidental Retrovesical Cyst in an Infant: A Case Report

Müllerian (paramesonephric) ducts are the primordial components of the female reproductive tract, and defects in their development can lead to a range of uterine anomalies, including hypoplasia, agenesis, and other structural abnormalities. Herlyn-Werner-Wunderlich (HWW) syndrome is a rare variant of Müllerian duct anomalies characterized by uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. This syndrome is often diagnosed incidentally, typically presenting with symptoms related to urinary tract or reproductive system malformations. Early recognition is crucial to preventing complications such as infertility, chronic pain, and renal dysfunction. This case describes a six-month-old female infant, a product of in vitro fertilization, who was admitted to the neonatal intensive care unit due to persistent abdominal distention and vomiting. Initial investigations for Hirschsprung's disease were negative, and radiologic findings revealed a single kidney and grade III vesicoureteric reflux. At six months of age, the infant was readmitted with fever and recurrent vomiting. Imaging studies, including ultrasound and CT, revealed a large retrovesical cyst and left renal agenesis. An MRI demonstrated that the cyst arose from the uterus and vagina, likely due to a uterovaginal septum. Surgical intervention included vaginotomy and vaginoplasty, successfully resolving the cyst and restoring vaginal patency. Postoperative imaging confirmed an empty uterine cavity and no further cyst formation. This case underscores the importance of understanding the embryological development of the female reproductive and renal systems, as well as the early clinical suspicion of HWW syndrome. Timely diagnosis and intervention are critical to preventing complications such as obstructed menstruation, pelvic pain, and renal dysfunction. Despite its rarity, early recognition of this syndrome in infants and young children can significantly improve patient outcomes and quality of life.

Hemihysterectomy in a patient with uterus didelphys, vaginal septum and ipsilateral renal agenesis: A case report and literature review

Uterus didelphys is a rare Müllerian anomaly, often diagnosed during menarche or in women with a personal history of infertility and/or recurrent pregnancy loss. Its association with other genitourinary anomalies is frequent and may determine the existence of established syndromes. This case report refers to a 13-year-old female patient diagnosed with OHVIRA syndrome (Obstructed Hemivagina with Ipsilateral Renal Agenesis), a condition wherein the presence of a didelphic uterus is associated with hemivagina obstruction and ipsilateral renal agenesis. The patient presented with cyclic pelvic pain, related to the presence of hematocolpos and hematometra, which persisted despite several surgical approaches, including vaginal septum excision and correction of cervical stenosis. The recurrence of the condition indicated exploratory laparotomy, revealing two hemi-uteri and two uterine cervixes, with hematometra on the right. A subtotal hemihysterectomy was performed on the right. Post-procedure, the patient developed with regular menstrual cycles and improvement of pelvic pain complaints. Given the limited prevalence and low index of suspicion, the potential requirement for surgical intervention and its potential impact on reproductive future, diagnosing and treating OHVIRA syndrome and other Müllerian anomalies poses notable challenges in clinical practice. Hence, sharing different therapeutic approaches of a rare diagnosis with the scientific community is of paramount importance to aid in early diagnosis and effective management of similar clinical cases.

OHVIRA syndrome: clinical implications of a delayed diagnosis

Obstructed Hemi Vagina with Ipsilateral Renal Agenesis (OHVIRA) syndrome is a rarely encountered müllerian duct anomaly. Delayed diagnosis is common due to normal onset of puberty and menstruation. We report a case of a woman in her early 20s with a background history of multiple emergency department visits, ward admissions and surgeries for chronic abdominal pain. She was reviewed at 1 month postlaparotomy for recurrent pelvic abscess and was finally diagnosed to have an OHVIRA syndrome, 11 years after her first clinical presentation. Excision of the vaginal septum completely resolved her symptoms. We are reporting this case to highlight the clinical implications resulting from the delayed diagnosis, to look into factors contributing to the delay and to highlight the importance of having a high index of suspicion to diagnose this unique condition.

Endoscopic treatement by vaginoscopy of a Herlyn-Werner-Wunderlich syndrome: A case report

INTRODUCTION

Herlyn-Werner-Wunderlich syndrome is a rare complex congenital disorder, presenting with obstructed vagina, uterus didelphys and ipsilateral renal agenesis. Hemivaginal obstruction firstly asymptomatic, leads to symptoms after menarche such as dysmenorrhea, pelvic pain or infertility.

CASE PRESENTATION

A 15-year-old patient presenting with few symptoms, transvaginal ultrasound reveals an hematocolpos, we report also typical findings of this disorder on magnetic resonance imaging.

DISCUSSION

The pelvic pain caused by the hematocolpos is the main symptom that leads patients to consult often urgently, the MRI is the gold standard exam to confirm diagnosis, the treatment consists on incision the septum vaginal and leads to avoid complications.

CONCLUSION

Early diagnosis of this syndrome usually leads to initiate surgical treatment in order to avoid complications.