Obstructed Hemivagina And Ipsilateral Renal Agenesis Research Articles

Blind ectopic hemato-megaureter: A rare association with the rare obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome

Blind ectopic hemato-megaureter: A rare association with the rare obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome

Chronic Vaginal Discharge Syndrome Caused by Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA) Syndrome: A Case Report

Chronic Vaginal Discharge Syndrome Caused by Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA) Syndrome: A Case Report

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome–A “no-touch-approach”: A case report

<b>Introduction:</b> Herlyn-Werner-Wunderlich (HWW)/obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare Müllerian duct anomaly (MDA). Usually presenting after menarche classically with dysmenorrhea. Here we present a challenging case, where the diagnosis was missed initially.<br /> <b>Case presentation:</b> A 10-year-old girl presenting with dysmenorrhea and constipation, treated repeatedly with analgesics, laxatives and enema. A pelvic ultrasound and magnetic resonance imaging (MRI) confirmed the diagnosis of OHVIRA syndrome, which requires surgical intervention. We describe a “no -touch- technique” for resecting the septum. The patient had immediate relief of symptoms and a smooth post-operative recovery.<br /> <b>Conclusions:</b> Early diagnosis and surgical management are crucial not only to relieve symptoms but to prevent long term complications that may affect the patients’ reproductive potential. Despite pelvic ultrasound being an affordable and a useful diagnostic tool, the diagnosis can be missed by inexperienced operators. Therefore, MRI is recommended to confirm and classify MDAs. The hysteroscopic “no-touch-technique” to resect the septum is an effective, safe and a convenient approach to treat the condition while preserving hymen integrity.

Reconsidering the best minimally invasive approach for patients with herlyn-werner-wunderlich syndrome: Should we push the frontiers for a better outcome?

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare congenital defect of the Mullerian ducts characterized by uterine didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis. It frequently presents during puberty, with complications such as pelvic pain, pelvic inflammatory disease and infertility. Surgical management is the mainstay treatment. A vaginal access for septum resection is usually used. However, it can be in difficult in several situations such as a very proximal septum with a small bulge, or in the case of virgin patients with social considerations regarding the hymenal ring integrity. Thus, a laparoscopic approach may be a beneficial alternative. In particular, laparoscopic hemi hysterectomy has recently gained remarkable interest due to its added benefit of treating the cause rather than treating only the symptoms. It removes the source of the bleeding, thus stopping the flow. However, it transforms a bicornuate uterus into a unicornuate uterus, leading to some obstetrical concerns. Should we push the frontiers further and consider laparoscopic hemi hysterectomy for better outcomes as the mainstay management of patients with OHVIRA syndrome?

Vaginoscopic Resection of Oblique Vaginal Septum in OHVIRA Syndrome Before Menarche

To demonstrate vaginoscopic resection of the oblique vaginal septum in a girl with Obstructed Hemi Vagina and Ipsilateral Renal Agenesis (OHVIRA) syndrome, before menarche. Stepwise demonstration of surgical technique with narrated video footage. OHVIRA syndrome is a rare urogenital anomaly in which the patients present after menarche, with progressive dysmenorrhea and a palpable pelvic mass due to hematocolpos and hematometra on the obstructed side. Delay in diagnosis may cause endometriosis, pelvic adhesions, and infertility (1)(2). A 12-year-old, premenarchal girl with complaints of pelvic pain and an ultrasound report of right renal agenesis was referred to the urology department of our hospital. She was also found to have uterus didelphys and a loculated fluid collection behind the urinary bladder on ultrasonography and on MRI (Figure 1 & 2). A probable diagnosis of OHVIRA syndrome with mucocolpos was made (3). Vaginoscopy showed an obstructing bulging vaginal septum on the right side. The left uterine horn was inspected by hysteroscopy. The vaginal septum was incised vaginoscopically with monopolar cautery using Collins knife(4)(5)(6). The collected mucus was drained. Right cervix and the right uterine horn were visualized by hysteroscopy. Edges of the septum were resected with a resectoscope loop. The hymen was not injured during the surgery. Relook vaginoscopy done after two months showed a normal and healed vagina. Vaginoscopic resection of the obstructing oblique vaginal septum in OHVIRA syndrome is a very simple, minimally invasive and a virginity conserving surgery. Early diagnosis and treatment can prevent future complications due to cryptomenorrhea.

Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome: A Systematic Review about Diagnosis and Surgical Management.

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare congenital defect of the Müllerian ducts characterized by uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis. The aim of this systematic review is to summarize the main symptoms and presentation of the OHVIRA syndrome, as well as the different types of management, fertility, and obstetrical outcomes. A comprehensive search was performed in PubMed, EMBASE, SCOPUS, and Web of Science databases since inception to May 1, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. After duplicate records removed, the search strategy retrieved 103 articles. The full texts of 73 articles further were assessed for eligibility, and 44 studies were finally included in the systematic review. The mainstay surgical treatment of OHVIRA syndrome is usually a minimally invasive vaginal approach to remove the septum. Ultrasound-guided hysteroscopic resection and laparoscopic resection of the septum have been described as alternatives. Considering the feasibility of minimally invasive approach for the management of the syndrome, laparotomy should be avoided as much as possible and considered only in selected cases.

Novel approach to resection of an obstructing longitudinal septum with a microperforation and absent hematocolpos

Background: Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) is a rare urogenital tract malformation characterized by uterus didelphys, obstructed hemivagina and renal agenesis. Patients often present after menarche with cyclic dysmenorrhea and hematocolpos. Treatment is surgical resection of the obstructing septum. When microperforation of the longitudinal septum is present, the clinical picture can be more insidious. In addition, complete and safe surgical resection of the poorly delineated septal cavity is challenging.

Atypical OHVIRA syndrome: cases of chronic discharge

Background: Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) is a rare congenital syndrome that is difficult to diagnosis. Women typically present after menarche with dysmenorrhea and pelvic pain, and eventually have diagnostic imaging. Patients with unrecognized OHVIRA syndrome can develop infection, endometriosis, infertility, and pregnancy complications. In the following cases, chronic vaginal discharge was a key symptom for further work up and diagnosis.

A rare variant of obstructed hemivagina and ipsilateral renal agenesis and its improvement of classification

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) is a rare congenital malformation of the female reproductive organs, including uterine dysplasia, blind hemivagina, and ipsilateral renal dysplasia. It has a serious impact on patients' quality of life and fertility. We report a rare case of OHVIRA with a complete septate uterus, ectopic dysplasia of the left kidney, left ectopic ureter, and three oblique vaginal septa. The dysplastic left kidney and the ectopic ureter were removed during laparoscopy. In addition, the two layers of vaginal septa, which were ignored in the past 10 years, were removed by hysteroscopy. As the detection rate of OHVIRA has gradually increased, manifestations that previous classification systems could not recapitulate have emerged. By retrieving the relevant cases, we have tried to propose a new classification system, which would allow clinicians to have a complete understanding of the manifestations of OHVIRA and would be helpful in the treatment of patients.

Retroperitoneal teratoma with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome in infant

The reports of retroperitoneal teratoma or obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome were published respectively. But there were no reports of retroperitoneal teratoma with OHVIRA syndrome. Thus, we report a rare case of retroperitoneal teratoma with OHVIRA syndrome.

Resection of a Longitudinal Vaginal Septum in an Obstructed Hemi-Vagina

<h3>Study Objective</h3> The objective of this video is to review the diagnosis and management of obstructed hemi-vagina and ipsilateral renal agenesis (OHVIRA) and demonstrate a technique for resection of the longitudinal vaginal septum in a patient with OHVIRA. <h3>Design</h3> Not applicable. <h3>Setting</h3> Patient was placed in lithotomy position. <h3>Patients or Participants</h3> This is the case of a 22-year-old gravida 0 who presented with pelvic pain and vaginal discharge. Her physical exam was notable for a 5 cm fluctuant mass along the right vaginal wall. A pelvic ultrasound and MRI were consistent with Obstructed hemi-vagina and ipsilateral renal agenesis (OHVIRA). OHVIRA is a rare congenital abnormality of the Müllerian ducts, characterized by didelphys uterus, unilateral blind hemi-vagina, and ipsilateral renal agenesis. <h3>Interventions</h3> This video demonstrates a technique for resection of the longitudinal vaginal septum in a patient with OHVIRA. Optimal visualization of the septum was performed using vaginoscopy. A suction bulb was used to prevent outflow from the vagina, which allowed extension of the cavity with normal saline. Additionally, a sidekick needle was inserted through the septum into the obstructed vagina. This step was performed under ultrasound guidance to confirm proper needle placement, allowing distention of the blind hemi-vagina. The vaginal septum was then incised using the bipolar resectoscope. The resection of the septum was completed vaginally using the handheld Ligasure with subsequent visualization of both cervices. <h3>Measurements and Main Results</h3> Not applicable. <h3>Conclusion</h3> Surgical management and drainage of an obstructed hemi-vagina in a patient with OHVIRA is essential for symptom control. Prevention of re-accumulation of the fluid is achieved by complete resection of the septum. This can be facilitated by injecting a distending medium into the obstructed vagina. Trans-abdominal ultrasound can be helpful in confirming proper needle placement during this step, thus preventing vaginal wall damage during resection.

Aqueous vaginal contrast and scheduled hematocolpos with magnetic resonance imaging to delineate complex müllerian anomalies

To demonstrate the advantage of using aqueous vaginal contrast and scheduled hematocolpos with magnetic resonance imaging (MRI) to improve the delineation of gynecologic anatomy and to recommend that this modality be considered in patients with complex müllerian anomalies. Video demonstration of MRI adjuncts to improve visualization of gynecologic anatomy. Academic Hospital. A patient with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) who presented for definitive surgical management. OHVIRA is a unilateral obstructed müllerian anomaly that presents typically after menarche with progressively worsening dysmenorrhea caused by progressive distension of the obstructed hemivagina and uterine horn. The definitive treatment for this anomaly is resection of the unilateral obstruction. When the obstructed hemivagina is within close proximity to the patent hemivagina, vaginal septum resection should be performed to relieve the obstruction successfully. However, when the obstructed hemivagina and uterine horn are not adjacent to the patent hemivagina, a simple septum resection is not feasible and there is a high rate of restenosis if anastomosis is attempted. In this case, laparoscopic removal of the obstructed uterine horn, fallopian tube, cervix, and vagina should be considered as an alternative approach to resolving the obstruction. A surgical approach can be recommended only once the surgeon has a clear understanding of the patient's pelvic anatomy and the magnitude of the obstruction. In the presented case, a 17-year-old patient with OHVIRA presented for definitive surgical management. While on hormonal suppression, a pelvic MRI was performed that identified a uterus didelphys with a left hemiuterus and cervix communicating with a patent vagina. The right hemiuterus and cervix were measured 2.5 cm from the patent vagina. However, because of hormonal suppression, the vaginal cavity was decompressed, making it very difficult to discern the relationship between the two uteri and vaginas. To better determine whether vaginal septum resection to relieve the obstruction was feasible, norethindrone was discontinued to allow menstrual blood to fill the obstructed hemivagina followed by a subsequent pelvic MRI with aqueous vaginal contrast to fill the patent vagina with contrast gel to improve the visualization of the decompressed vaginal cavities. Advantage of aqueous vaginal contrast and scheduled hematocolpos with MRI to image pelvic anatomy in a patient with a complex müllerian anomaly to guide surgical decision-making. The addition of vaginal aqueous contrast clearly delineated the course and caliber of the patent vagina and its relationship to the obstructed hemivagina, now filled with blood. The inferior margin was in closer proximity to the patent vagina, but with only a very narrow segment (<1 cm) adjacent to the patent vagina and the obstructed cervix was displaced superiorly, now measuring 3.5 cm above the patent vagina. Surgical management options were discussed with the patient, and given the superior location of the obstructed uterus and cervix with only a narrow border of the vagina in continuity with the patent vagina, the risk of postoperative stenosis after vaginal septum resection was determined to be too high. The decision was made to proceed with a laparoscopic resection of the obstructed right side, and the patient underwent laparoscopic resection of the right hemiuterus, fallopian tube, cervix, and vagina. Intraoperatively, a survey of the pelvis again confirmed that the two vaginas were too far to reconnect safely without a high risk of stenosis. The patient recovered without complications postoperatively and her menses resumed without any pain. We highlight the use of two techniques to optimize MRI imaging of pelvic anatomy in a patient with a complex müllerian anomaly. First, the use of aqueous vaginal contrast with MRI is advantageous to clearly delineate the course and caliber of the patent vagina in patients with complex gynecologic anatomy. Second, cessation of hormonal suppression to allow menstruation to cause hematocolpos helped delineate the relationship between the obstructed vagina and patent vagina. In the presented case, these MRI adjuncts provided necessary detail that could not be appreciated with standard MRI to confirm that vaginal septum resection to preserve the right uterus would be too high a risk for postoperative stenosis in this patient. Aqueous vaginal contrast and scheduled hematocolpos should be considered as adjuncts to MRI when standard imaging modalities are unable to clearly describe the relationship between pelvic structures in cases of complex müllerian anomalies to help guide treatment recommendations.

Vaginoscopic Incision of Oblique Vaginal Septum in Adolescents with OHVIRA Syndrome

This study is to evaluate the efficacy and safety of vaginoscopic incision of oblique vaginal septum in adolescents with Obstructed hemi-vagina and ipsilateral renal agenesis (OHVIRA) syndrome. It is about Fourteen adolescents with OHVIRA syndrome managed by vaginoscopic incision of the oblique vaginal septum using a “No-touch” technique over an 8-year period. In all fourteen adolescents with OHVIRA the oblique vaginal septum was incised successfully without any intraoperative complications. Postoperative pain was unremarkable and each patient’s symptoms resolved postoperatively. The 3-month postoperative follow up office vaginoscopy revealed that the vaginal septum had not reformed nor was any vaginal stenosis noted. Vaginoscopic incision of the oblique vaginal septum using a “No-Touch” technique is a safe, minimally invasive, and effective approach for treating OHVIRA syndrome in adolescents with hematocolpos. This technique may be utilized to minimize disruption to the undeveloped vaginal wall and postoperative pain while providing excellent surgical visualization throughout the procedure.

OHVIRA syndrome in an infant girl

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) is a rare congenital urogenital anomaly, which usually presents after menarche. We report a 3-month-old infant who presented with recurrent urinary tract infections (UTI) and had an abdominal lump. Radiological investigations revealed absent right kidney, hydronephrotic left kidney, and a cystic pelvic mass. Exploratory laparotomy revealed hydrometrocolpos which was evacuated. During 1-year follow-up, hydronephrosis decreased, there were no further UTI, and kidney function remained normal. Our case illustrates that OHVIRA syndrome may present in early infancy with UTI, renal anomalies, and pelvic mass.

Herlyn Werner Wunderlich Syndrome with Hematocolpos: An Unusual Case Report of Full Diagnostic Approach and Treatment.

Herlyn-Werner-Wunderlich (HWW) syndrome is an uncommon combined müllerian duct anomalies (MDAs) and mesonephric duct malformation of female urogenital tract characterized by uterus didelphys and obstructed hemi-vagina and ipsilateral renal agenesis (OHVIRA) syndrome. We present a rare and unusual case of this syndrome in a 19 year-old female who suffered from hypomenorrhoea and abdominal pain. She had an obstructed hemi-vagina on right side which led to marked distention of ipsilateral cervix, while proximal hemi-vagina compressed the contralateral side causing its partial obstruction resulting in hypomenorrhoea. Understanding the imaging findings of this rare condition is important for early diagnosis in order to prevent complications which may lead to infertility.

Management of Hematometra in Single Horn of Didelphic Uterus with Obstructed Hemivagina and Ipsilateral Renal Agenesis Syndrome: A Case Report with Brief Review of Literature

ABSTRACT The triad of uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare entity. These cases are difficult to diagnose due to heterogeneous presentation and rarity of the condition. Ultrasonography and magnetic resonance imaging are important for initial diagnosis; however, laparoscopy is required for the confirmation of the diagnosis. Early and accurate diagnosis of this condition followed by prompt surgical therapy is essential to prevent complications and to preserve future fertility. Here we report a case of uterus didelphys with hemivagina and ipsilateral renal agenesis with hematometra and hematosalpinx in a young girl. How to cite this article Mishra VV, Agarwal R, Bandwal P, Choudhary S, Gandhi K. Management of Hematometra in Single Horn of Didelphic Uterus with Obstructed Hemivagina and Ipsilateral Renal Agenesis Syndrome: A Case Report with Brief Review of Literature. J South Asian Feder Obst Gynae 2016;8(3):231-235.

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome should be redefined as ipsilateral renal anomalies: Cases of symptomatic atrophic and dysplastic kidney with ectopic ureter to obstructed hemivagina

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare syndrome characterized by mullerian and renal anomalies. Renal agenesis is classically considered to be part of the definition of OHVIRA syndrome. There are increasing reports that the lack of an ipsilateral kidney on imaging studies is not from true renal agenesis but renal dysplasia and atrophy. We have observed cases where this ipsilateral dysplastic and atrophic kidney leads to clinical symptoms. The objective of this study is to report cases of OHVIRA syndrome where an ipsilateral dysplastic and atrophic kidney led to clinical symptoms, and to raise awareness in the pediatric urology community of this variant of OHVIRA syndrome. All cases of OHVIRA syndrome with an ipsilateral dysplastic and atrophic kidney were identified from January 2010 to June 2013. The patient's presentation, clinical course, surgical management, radiologic findings, and pathologic finding were reviewed. There were three cases of OHVIRA syndrome with a symptomatic ipsilateral dysplastic and atrophic kidney identified. All three of these dysplastic and atrophic kidneys had an ectopic ureter to the obstructed hemivagina and led to persistent vaginal drainage after resection of the vaginal septum. These dysplastic and atrophic kidneys were not visualized on any imaging studies. Laparoscopic removal of the dysplastic and atrophic kidney led to cessation of vaginal drainage in all cases. This study reports additional cases to the literature that do not fit the classic definition of OHVIRA syndrome. In the cases in this study, there was no ipsilateral renal agenesis, but an ipsilateral dysplastic and atrophic kidney with an ectopic ureter to the obstructed hemivagina. In addition, these cases demonstrate that the dysplastic and atrophic kidney may cause symptoms such as persistent vaginal drainage after resection of vaginal septum. The dysplastic and atrophic kidneys may not be detected by any imaging modality including MRI and DMSA scan and may be ectopic in location. All three of our cases had persistent vaginal drainage after resection of the vaginal septum which was cured by removal of the dysplastic and atrophic kidney ipsilateral to the obstructed hemivagina. The limitations of this study include the small number of patients and retrospective nature. While the classic definition of OHVIRA syndrome includes ipsilateral renal agenesis, there is increasing evidence that the absence of a kidney on imaging is due to renal dysplasia and atrophy and not true renal agenesis. In addition, we have observed that this dysplastic and atrophic kidney may cause clinically significant issues such as persistent vaginal drainage through an ectopic ureter to the ipsilateral hemivagina after resection of vaginal septum. This small dysplastic and atrophic kidney may not be visualized on imaging studies and laparoscopy can be diagnostic and therapeutic if indicated. Ipsilateral renal anomalies, not ipsilateral renal agenesis, should be considered part of the definition of OHVIRA syndrome. Pediatric urologists need to be aware of the spectrum of renal anomalies in OHVIRA syndrome.

A rare case of OHVIRA in an adolescent presenting with dysmenorrhea: A case report

Here we present a rare case of complex uterine anomaly with Obstructed Hemivagina and ipsilateral renal agenesis (OHVIRA), also known as the Herlyn-Werner-Wunderlich syndrome (HWWS). A 16-year-old girl presenting with dysmenorrhea underwent ultrasonography, intravenous urogram (IVU), and magnetic resonance imaging (MRI) of kidney, ureter, and bladder (KUB). An abdominopelvic MRI was found to be very effective in reaching appropriate diagnosis with the avoidance of interventions like laparoscopy or laparotomy, which was needed in the past to diagnose this rare anomaly. We also discuss the embryopathogenesis of this anomaly and review the literature.

Herlyn-Werner-Wunderlich Syndrome in a 35-Year-Old Female: A Rare Case

Abstract Background: Herlyn-Werner-Wunderlich Syndrome (HWW Syndrome), also known as OHVIRA (obstructed hemivagina and ipsilateral renal agenesis) syndrome is a rare congenital anomaly of uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis. The defect is usually diagnosed in adolescents after menarche in patients with dysmenorrhea and vaginal or pelvic masses. Case: This syndrome's appearance was delayed in a patient until she reached the age of 35. Hemihysterectomy and septectomy were performed in this patient. Results: The patient's postoperative period was uneventful and she was discharged after 5 days in the hospital. Conclusions: Treatment should be individualized depending on the age, symptoms, and obstetric history of each individual patient. (J GYNECOL SURG 30:177)

Using the Tracheobronchial Stent to Achieve Vaginal Patency After Repeated Failed Attempts in a Patient With OHVIRA

OHVIRA syndrome (obstructed hemivagina and ipsilateral renal agenesis) also known as Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare Mullerian duct anomaly. Surgical management can be difficult, especially if the level of obstruction is high, and there is a chance of re-obstruction requiring further surgical procedures. Successful use of a tracheobronchial stent to maintain vaginal patency has been previously described in a patient with OHVIRA undergoing a primary procedure.1 However, this is the first reported case of successfully achieving vaginal patency with the tracheobronchial stent in a patient with OHIVRA who had previously re-obstructed twice. A 13 year-old G0 female presented to the E.R. with a chief complaint of increasing intermittent lower abdominal and low back pain for the past few months. Patient had menarche at age 11 with normal cyclic menses lasting 5-7 days. On exam, a moderately sized palpable mass was noted 4 cm below her umbilicus. Pelvic ultrasound revealed an 11x7x9cm mass and the CT scan identified an absent left kidney, marked left hematosalpinx, uterine didelphys and left hematometrocolpos. The patient underwent resection and marsupialization of the left vaginal septum with evacuation of the hematometrocolpos. However, 3 weeks postoperatively, she developed significant lower abdominal pain and low-grade fever with leukocytosis. Imaging at that time suggested a tubo-ovarian abscess as a cause of her symptoms. She then underwent a laparoscopy, which was converted to a laparotomy when it was discovered she had a 10cm left tubo-ovarian abscess and complete re-obstruction of her left vagina. A left salpingo-oophorectomy and reopening of the left vaginal cuff with placement of a 24 French foley catheter was performed. The catheter was kept in place for 6 weeks and then removed in the office. Two weeks after removal, patient developed lower abdominal pain and imaging showed a 2.5 cm hematometra. Patient underwent re-opening of her obstructed left vagina and an 18x40mm AERO tracheobronchial stent was placed. Two months later, the stent was removed. One-year after removal of the stent, she is having normal menses, no pain and no evidence of re-obstruction. Obstructed hemivagina and ipsilateral renal agenesis(OHVIRA) constitutes about 0.16-10% of all Mullerian anomalies.2 The arrest of the ipsilateral mesonephric duct at 8 weeks of gestation is the believed to be the cause of the obstructed hemivagina.2 The mean age of presentation is 14 years and patients typically present with vague symptoms such as dysmenorrhea, abdominal pain and occasionally a pelvic mass. Initial management with imaging such as ultrasonography can help aid in diagnosis of OHVIRA. A retrospective case series of 27 patients concluded that OHVIRA syndrome can be surgically management solely with single-stage vaginoplasty.3 However, complications such as vaginal stenosis can arise especially if the level of obstruction is high in the vagina. This case demonstrates that tracheobronchial stents can be successful in achieving vaginal patency in patients who have failed their primary vaginoplasty. 1.Cooper, Amber and Merritt, Diane F. “Novel use of a tracheobronchial stent in a patient with uterine didelphys and obstructed hemivagina.” Fertility and Sterility. 93(3). 2010 900-03. Print2.Cox, Deven, and Ching, Brian."Herlyn-Werner-Wunderlich syndrome: a rare presentation with pyocolpos." Radiology Case. 6.3 (2012): 9-15. Print.3.Smith, Nicole and Laufer, Marc. “ Obstructed hemivagina and ipsilateral renal anomaly(OHVIRA) syndrome: management and follow up.” Fertility and Sterility. 87(4). 2007. 918-22. Print