An unusual complication of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome.

Abstract

We read with interest the report by Zivkovic et al. [1] entitled ‘‘Unusual case of OHVIRA syndrome with complication’’. Mullerian duct anomalies are rare congenital female genital tract anomalies that are divided into seven classifications and subtypes. Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is characterized mainly by uterus didelphys, septate uterus, an obstructed hemivagina, and renal agenesis. The most common complications associated with Mullerian anomalies include endometriosis, dysmenorrhea, cervix hematoma, abortion, and premature birth. The case reported by Zivkovic et al. [1] is a very rare complication of intrapartal rupture during delivery. We have also experienced very rare case of OHVIRA syndrome. A 35-year-old gravida 0 female was transferred to our institution for uterine myoma and uterine anomalies. Pelvic examination revealed a large uterus, double cervix, and hard palpable mass in the left vagina wall. CT revealed a suspicious underlying hemivaginal obstruction, hematoma with calcification, left renal agenesis with uterus didelphys, and subserosal myomas (Fig. 1a). MRI revealed uterus didelphys with a left hemivaginal obstruction, a large adenomyotic cyst in the left cervix, and left renal agenesis (Fig. 1b). The calcified mass in our patient had formed secondary to old menstrual blood. Our patient was unaware of her calcified vaginal masses before CT or MRI examination. Classification of Mullerian duct anomalies depends mainly on fusion of the Mullerian ducts. Therefore, unclassified Mullerian duct anomalies or uncommon complications are found incidentally. Addition of our case of OHVIRA syndrome with vaginal calcified masses such as stones to cases of vaginal rupture during delivery will provide clinically useful information to obstetricians and other readers.