Elsevier

Journal of Minimally Invasive Gynecology

Volume 21, Issue 6, November–December 2014, Pages 1113-1117
Journal of Minimally Invasive Gynecology

Case Report
Hemivaginal Septum Resection in a Patient With a Rare Variant of Herlyn-Werner-Wunderlich Syndrome

https://doi.org/10.1016/j.jmig.2014.05.001Get rights and content

Abstract

Herlyn-Werner-Wunderlich syndrome is characterized by a triad of uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. The syndrome should be suspected in any young woman with abdominal pain or cyclic dysmenorrhea, and radiologic evidence of müllerian duct and renal anomalies. Herein is presented the case of a 25-year-old woman with a rare variant of Herlyn-Werner-Wunderlich syndrome, characterized by an anomalous connection between the 2 endocervical canals, who underwent hemivaginal septum resection to relieve progressively worsening dysmenorrhea. The right hemivaginal septum was resected medially from the left cervix and laterally off the right vaginal wall. Hydrodissection between the hemivaginal septum and right cervix facilitated surgical resection. After resection of the hemivaginal septum there was complete resolution of dysmenorrhea and no recurrence of hematometra or hematocolpos.

Section snippets

Case Report

A 25-year-old woman, gravida 0, underwent evaluation of dysmenorrhea. Her menses, although previously regular, had become increasingly painful and longer during the past year. These symptoms remained refractory to nonsteroidal anti-inflammatory drugs and cyclic oral contraceptive pills. Her gynecologic history was significant for menarche at age 12 years. Her medical and surgical history was noncontributory. Transvaginal and transabdominal ultrasonography was performed, which revealed a uterine

Discussion

According to the American Society for Reproductive Medicine classification of müllerian duct anomalies, HWW syndrome is a class III anomaly 4, 5. The putative embryonic pathogenesis is likely due to disruption in the development of the caudal portion of 1 mesonephric duct, with secondary involvement of the ipsilateral müllerian duct 1, 6. The incidence of uterine didelphys, related to HWW syndrome, ranges between 1 in 2000 to 1 in 28 000 [2]. A complete or partial vaginal septum may occur in

Acknowledgments

We thank Beverly Eisenhuth, DO, for proofreading the manuscript.

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Disclosures: None declared.

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