OHVIRA-syndrome in a newborn

A rare case of obstructed hemivagina with uterus didelphys and ipsilateral renal anomaly syndrome

Obstructed hemivagina and ipsilateral renal anomaly syndrome, also known as Herlyn-Werner-Wunderlich syndrome, represents a rare congenital anomaly characterized by the presence of an obstructed hemivagina with uterus didelphys and concomitant ipsilateral renal abnormalities. Typically, the clinical presentation includes cyclical abdominal pain, vaginal discharge, and/or a vaginal mass occurring post-menarche. Accurate diagnosis requires a high index of suspicion among clinicians, coupled with a comprehensive understanding of the distinctive features associated with this anomaly. Herein, we present the case of a 13-year-old female patient who complained of persistent lower abdominal pain. Magnetic resonance imaging confirmed the diagnosis of obstructed hemivagina and ipsilateral renal anomaly syndrome, and the patient was successfully treated with a laparotomy involving blood aspiration and hysterectomy. This case report highlights the significance of clinical awareness, prompt diagnosis, and timely therapeutic interventions to mitigate the adverse effects and optimize outcomes in individuals affected by obstructed hemivagina and ipsilateral renal anomaly syndrome.

Obstructed Hemivagina and Ipsilateral Renal Agenesis Syndrome in a Neonate

Obstructed hemivagina with an ipsilateral renal anomaly (OHVIRA) syndrome is a congenital malformation that presents as a uterine didelphys with an obstructed hemivagina and an associated ipsilateral renal aberration. The clinical symptoms usually manifest after menarche. Unlike the typical presentation in adolescence, this case report features a neonatal presentation of OHVIRA syndrome with an unusual renal association. A female twin delivered at 35 weeks of gestation was transferred to our institution after birth from an outside hospital due to respiratory distress and for evaluation of the left multicystic dysplastic kidney identified on prenatal ultrasound. Physical examination and lab results, including a complete blood count, and a basic metabolic panel, including blood urea and serum creatinine, were within the normal range for age. Abdominal and pelvic ultrasound showed multicystic dysplastic left pelvic kidney, congenital hepatic cyst measuring 6 mm, uterine didelphys with duplication of the vaginal canal, and obstructed left hemivagina corresponding to the OHVIRA syndrome. Further testing revealed a normal chromosomal microarray, small patent foramen ovale on the echocardiogram, no vertebral or rib anomalies on the spinal x-ray, normal hearing test, and mild optic cupping on the ophthalmological evaluation. The pediatric surgeon and urologist recommended an outpatient follow-up and elective surgery in the future. This is a unique case presenting in the neonatal period with an unusual association. Timely intervention can help prevent obstetric complications.

Herlyn-Werner-Wunderlich Syndrome: A Rare Case Report

Müllerian anomalies are a complex spectrum of congenital defects of the female reproductive tract caused by an interruption in the normal development of Müllerian ducts and their associated structures. The clinical presentation of these anomalies varies and includes acute presentations. In this report, a case of a 16-year-old girl who attended the emergency department with severe colicky abdominal pain and nausea has been presented. The patient was on the fifth day of the menstrual cycle, and her pain was not completely relieved by the administration of non-steroidal anti-inflammatory drugs. The patient had menarche at the age of 14 years and used to have a regular menstrual cycle every 30 days. Her menstrual flow was average with a cycle duration of five days. An abdominal ultrasound examination was performed to rule out ovarian torsion, which demonstrated normal appearance and ovary size, and a large heterogeneous collection in the rectouterine pouch with unclear uterine morphology. Subsequently, magnetic resonance imaging revealed a duplication of the uterus, cervix, and vagina. The right hemivagina and right endometrial cavity were distended, consistent with hematometrocolpos. Right renal agenesis with compensatory hypertrophy of the left kidney was observed. The constellation of uterus didelphys obstructed hemivagina, and ipsilateral renal agenesis represented the diagnosis of Herlyn-Werner-Wunderlich syndrome. Herlyn-Werner-Wunderlich syndrome is a rare and complex type of congenital uterine abnormality. Although rare, this syndrome should be considered in the differential diagnosis of severe dysmenorrhea in adolescent girls with renal anomalies. In this case, the patient underwent vaginoplasty with resection of the vaginal septum to relieve the obstruction. At follow-up visits, she did not have a recurrence of symptoms.