Obstructed Hemivagina And Ipsilateral Renal Anomaly Research Articles

Addressing the delayed diagnosis of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome for improved women health in Africa: A case series

Background: Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome, a rare urogenital anomaly, presents significant challenges to young girls and women in Africa. As we strive to break barriers and reposition Africa in the global health architecture, the timely recognition and management of OHVIRA becomes crucial. Usingt a retrospective case series approach, we examined OHVIRA cases managed by the Pediatric and Adolescent Gynecology Unit at a Tertiary Health facility in Malaysia, between June and November 2022. The study findings have relevance for Africa because the challenges faced by young girls and women in obtaining adequate healthcare are not confined by borders.
 Results: The age range of presentation, 11-25 years, mirrors the age group of concern for the African population. The time interval between symptom onset and diagnosis, spanning from 1 to 12 years, raises concerns about delayed identification. We observed that worsening dysmenorrhea, often unresponsive to analgesia, was the main presenting symptom, accompanied by complications, such as persistent vaginal discharge (12.5%), urinary retention (25%), constipation (12.5%), and pelvic masses (37.5%), which resonate with potential cases in Africa.
 Conclusion: The delayed diagnosis of OHVIRA syndrome emphasizes the pressing need for proactive healthcare interventions, particularly among young girls and women in Africa. By understanding the parallels between our study and the challenges faced by young women on the continent, we can identify opportunities to improve healthcare access and address the barriers that hinder timely diagnosis and management.

Obstructed Hemivagina and Renal Anomalies in Patients with and without Anorectal Malformations

Study ObjectiveTo compare the anatomic variation between patients with a diagnosis of obstructed hemivagina with an anorectal malformation (ARM) and those without ARM. MethodsThis was a retrospective chart review conducted at a single tertiary Children's Hospital. Patients with an obstructed hemivagina seen from 2004 to 2019 were included. ResultsWe identified a total of 9 patients diagnosed with obstructed hemivagina: 4 patients with history of ARM and 5 patients without ARM. Patients presented with obstructive symptoms between the ages of 11 and 20. Two-thirds of patients had a left sided obstruction. All patients without ARM had ipsilateral congenital anomalies of the kidney and urinary tract. Half the patients with a history of ARM had an ipsilateral renal anomaly and the other half had a contralateral renal anomaly. ConclusionsObstructed hemivagina occurs in patients with a history of anorectal malformation. However, unlike patients with isolated obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), patients with ARM and an obstructed hemivagina can present with associated renal anomalies on either the ipsilateral or contralateral side. In our small case series, patients with history of ARM had high septa and required more complex surgical management due to the inability to access the septum vaginally. Knowledge of renal anatomy and ureteral path is important since hysterectomy may be needed to relieve the obstruction in patients with ARM. A larger case series is needed to better characterize the spectrum of complex anomalies in patients with anorectal malformations.

Surgical Management of OHVIRA and Outcomes

Study ObjectiveObstructed hemivagina and ipsilateral renal anomaly (OHVIRA) includes uterine didelphys, unilateral obstructed hemivagina, and ipsilateral renal anomaly. Surgical management of this condition relies on accurate diagnosis to excise the obstructed longitudinal vaginal septum (OLVS). Vital considerations involve identifying the side affected, ipsilateral renal anomaly (IRA), thickness of the septum (TS), septal axis (SA), and distance of the septum to perineum (DSP). The study aimed to evaluate the preoperative characteristics, imaging findings, and surgical outcomes of OHVIRA. MethodsInstitutional review board approval was obtained for this retrospective chart review. ICD-10 codes identified OHVIRA cases between 2012 and 2019 at a single children's hospital. Patient demographic characteristics, magnetic resonance imaging findings, surgical management, outcomes, and complications were reviewed. Descriptive statistics were utilized. ResultsTwenty-six patients met inclusion criteria. Most were diagnosed at puberty (92%). Abdominal pain (50%) was the most common presenting complaint. The mean age of diagnosis was 13.2 years overall and 11.2 years for those with regular cycles vs 13.4 years for those with irregular cycles. Preoperative imaging showed predominant right-sided OLVS (50%), IRA (77%), and oblique SA (65%). All patients underwent vaginoscopy, septum resection, and vaginoplasty, except 1 who was managed with an abdominal drain as a neonate. Four required postoperative vaginal stent or Foley, with DSP greater than 5 cm in all cases. One intraabdominal abscess complication occurred. No instances of hematocolpos re-accumulation or reoperation were observed during the 3-year follow-up period. ConclusionThis study demonstrates that detailed preoperative planning and a systematic surgical approach lead to favorable outcomes in OHVIRA irrespective of the OLVS laterality, TS, SA, or DSP.

#393 : Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) — A Series of 6 Cases at a Tertiary Referral Centre

Background and Aims: OHVIRA is a rare congenital urogenital anomaly. Diagnosis is often delayed because patients have normal onset of puberty and menstruation if there is partial obstruction with a communicating fenestration in the hemivagina. Symptoms can be non-specific such as abdominal pain and dysmenorrhoea, but urinary retention and a pelvic mass have been reported. Haematocolpos can cause anatomical distortion, making imaging difficult. Definitive management is by vaginoplasty but that can be complex, especially in an anatomically small child, or cases with chronic inflammation. Retrograde bleeding during obstruction is common, leading to endometriosis and ascending infection. This is associated with complex surgery, increased morbidity and subfertility, which is why early diagnosis and timely management are important. Method: Medical records were retrieved from 6 patients with OHVIRA treated between 1 April 2021 and 31 March 2023 at a tertiary referral centre. For each patient, age of diagnosis, referral source, symptoms, diagnostic investigations, diagnostic challenges, anatomical findings, surgical managements, complications and outcomes were reviewed. Results: Patient’s ages ranged from 10 to 33 years. Median age of diagnosis was 30. Cases were referred from paediatric surgery (n=1), gynaecology (n=2), general surgery (n=2) and urology (n=1). Symptoms included abdominal pain (n=4), pyrexia (n=2), intra-menstrual bleeding (n=2) and vaginal discharge (n=1). 3 patients had been misdiagnosed before referral. All had unilateral haematocolpos and underwent ultrasound (n=6) and either MRI (n=4) or CT (n=2), followed by vaginoplasty. 2 patients had emergency surgery for pelvic abscesses. There were no intra- or post-operative complications, or adverse outcomes. Conclusion: Median age at diagnosis was advanced, and symptoms and referral source were variable. Misdiagnosis was frequent. Surgical management was successful with a single stage vaginoplasty. Ascending infection can be a consequence of delayed diagnosis and management. It is important to evaluate any female with dysplastic or absent kidneys for uterovaginal abnormalities.

Management of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome and diminished ovarian reserve a video article

Management of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome and diminished ovarian reserve a video article

Diagnostic challenge in a case of foul-smelling vaginal discharge in a newly attained menarche girl

Foul-smelling vaginal discharge in adolescents often stems from infectious origin, foreign body insertion, neoplasm, congenital anomaly, and sexual abuse. Diagnosing the causes of the discharge remains challenging, especially in cases where sexual and reproductive health awareness is relatively low in the population from marginalized ethnographies and socio-cultural backgrounds. Suspicion of sexual abuse must be explored carefully and sensitively. A history of sexual exposure might not be forthcoming in adolescents where premarital sex is frowned upon. The process of eliciting the causation may be a challenge to healthcare professionals, delaying the diagnosis and subsequent management. In rare circumstances, imaging studies may help confirm the origin of the infection, giving insight into the presentation’s aetiology. We describe a case of Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome presented with foul-smelling vaginal discharge in a newly attained menarche girl in the North-East region of Peninsular Malaysia. We also discussed the theories and reasons behind the occurrence of such a presentation, along with the diagnostic dilemma in this current case.

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome: A case report

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome: A case report

29. Case report: Long term follow up of neonate presenting with acute kidney injury secondary to obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome

29. Case report: Long term follow up of neonate presenting with acute kidney injury secondary to obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome

Minimally Invasive Surgical Approach to Tubo-Ovarian Abscess in Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome

<h3>Study Objective</h3> We present a case of an acute presentation of tubo-ovarian abscess in the setting of Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome in a non-sexually active adolescent, and demonstrate the surgical principles and techniques used int the management of the tubo-ovarian abscess and obstructed hemivagina/septum. <h3>Design</h3> Case report and surgical video. <h3>Setting</h3> Vaginoscopy and four port laparoscopy. <h3>Patients or Participants</h3> An adolescent female who has never been sexually active, presenting with a tubo-ovarian abscess on a background of OHVIRA syndrome. <h3>Interventions</h3> Vaginoscopy for identification of patent cervix and vaginal septum, laparoscopic drainage of tubo-ovarian abscess, adhesiolysis, and right salpingectomy, vaginoscopic septal resection with monopolar Collins knife. <h3>Measurements and Main Results</h3> A 15-year-old female, who had never been sexually active, presented with lower abdominal pain, fevers and malodorous vaginal discharge. Imaging of the pelvis demonstrated a right tubo-ovarian abscess of 5.8 × 4.7 × 5.8cm, uterine didelphys, obstructed right vaginal cavity, and right renal agenesis, suggesting OHVIRA syndrome. Medical management with intravenous antibiotics was unsuccessful, and the patient was managed surgically in a minimally invasive manner. Vaginoscopy identified a normal left cervix, and a small perforation was noted in the vaginal septum. Laparoscopy revealed a right sided tubo-ovarian complex adherent to the right pelvic side wall, bowel, and omentum. Blunt dissection and electrosurgical techniques were used to adhere to tissue planes. Drainage of multiple collections and a subsequent right salpingectomy was performed. A monopolar Collins knife was used with the vaginoscopy to resect the vaginal septum. The patient recovered well and was discharged shortly after her procedure. <h3>Conclusion</h3> Vaginoscopic septal resection is feasible in the setting of OHVIRA syndrome and in non-sexually active patients. Pre-operative imaging allows correct diagnosis of OHVIRA and assist in surgical planning. Care must be taken in tissue dissection to avoid injury.

7986 Laparoscopic Left Adnexal Cystectomy in a Pediatric Patient with Infected Ohvira

<h3>Study Objective</h3> Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) is an abnormality of Mullerian development typically diagnosed after menarche with painful menses due to the obstructed outflow of one hemivagina. Microperforations may occur in the vaginal septum which can lead to infected hematometrocolpos, intermenstrual bleeding, and abnormal discharge. <h3>Design</h3> We present a video demonstrating the case of a twelve-year-old girl with history of renal anomaly and painful menses with intermenstrual bleeding and persistent discharge. Preoperative imaging suggested OHVIRA with an eight-centimeter adnexal cyst on preoperative imaging. Differential diagnosis of the adnexal cyst included tubo-ovarian abscess, ovarian or paratubal cyst, and ectopic ureter leading to a fluid collection. <h3>Setting</h3> Concurrent laparoscopic and vaginal surgery at an academic children's hospital medical center. <h3>Patients or Participants</h3> Twelve-year-old girl with history of renal anomaly and gynecologic symptoms. <h3>Interventions</h3> The vaginal septum was removed in the operating room, revealing purulent hematocolpos consistent with infection. Laparoscopy allowed for diagnosis of paratubal cyst with adnexal inflammation and concurrent cystectomy, in addition to permitting confirmation of uterine anatomy for future guidance. <h3>Measurements and Main Results</h3> Postoperatively, the patient healed well from laparoscopy. Her vaginas were unified, and she was counseled that she has two cervices and hemi-uteri for future gynecologic planning. <h3>Conclusion</h3> While a majority of cases of OHVIRA may be surgically corrected with vaginal surgery alone, the addition of laparoscopy allowed for diagnosis and treatment of the concurrent paratubal cyst at the time of vaginal septum resection.

UTERINE DIDELPHYS WITH OBSTRUCTED HEMIVGINA AND IPSILATERAL RENAL ANOMALY (OHVIRA) SYNDROME: A RARE CASE STUDY

Uternie didelphys with obstructed Hemivagina and ipsilateral Renal anomaly (OHVIRA) syndrome is a rare congenital anomaly. These patients may present with varied symptoms. Hence may often get misdiagnosed or may go undiagnosed till a later age as the patient may be asymptomatic. We present here such an unusual case of a 36yrs old married female who came to our OPD with diffuse pain abdomen associated with dysmenorrhoea and was later diagnosed on MRI with OHVIRA syndrome who underwent septal resection and was relieved from the symptoms.

Herlyn-Werner-Wunderlich Syndrome in a young female mimicking acute appendicitis

Abstract Objective Herlyn-Werner-Wunderlich (HWW) Syndrome, also known as Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome, is a very rare congenital urogenital tract anomaly. The incidence of the syndrome is less than 1/1,000,000 females. OHVIRA syndrome radiologically presents as the Wunderlich triad: uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis. Clinical presentation is progressive dysmenorrhea beginning with the menarche. If unilateral renal agenesis is diagnosed in a female newborn, gynecological exams should be performed to exclude corresponding genital anomalies. We present here a case of OHVIRA syndrome mimicking acute appendicitis. Methods A 12-year-old recently menarched female presented to our emergency department with lower abdominal pain and nausea without vomiting. The pain started two days earlier and it was the first such episode. The abdomen was tender in the right lower quadrant with no alarming signs. WBC count and CRP were normal. Abdominal ultrasound suggested acute appendicitis (without clear visualization of the appendix) and also revealed left renal agenesis. Performed abdominal MRI confirmed renal agenesis and uterine malformation with 2 uterine bodies, 2 cervical uteri and a closed hemi-vagina with hematocolpos. Results With the diagnosis of the rare OHVIRA syndrome and the visualization of a healthy appendix the cause of the pain was identified. The patient was hospitalized for one night to control pain and a treatment with oral contraception was introduced to suppress the hormonal cycle. Since pain was not well controlled the patient returned to the emergency department two days later. Indication for surgical treatment was made and the blood filled hemivagina incised, drained and marsupialised. Oral contraception (Dienogest) was prescribed. Further gynecological follow-up and corrective surgery are planned. Conclusion OHVIRA syndrome is very rare and may mislead physicians presuming other pathologies such as acute appendicitis. In young women presenting with abdominal pain, OHVIRA should be taken into account. Ultrasound and MRI are the imagery of choice, especially in fertile young women. Rapid and complete diagnosis is necessary to treat correctly and prevent complications. Moreover, detected genitourinary malformations should always lead to further investigations of concomitants pathologies.

Surgical Management of OHVIRA and Outcomes

Background: One of the most complex müllerian anomalies is uterine didelphys with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA). The surgical management of this condition relies on accurate diagnosis to determine side affected, concurrent ipsilateral renal anomaly (IRA), thickness of the septum (TS), septal axis (SA) and distance of the septum to the perineum (DSP) for excision of the obstructed longitudinal vaginal septum (OLVS). We sought to assess the preoperative characteristics and surgical outcomes for OHVIRA.

Obstructed Hemivagina and Ipsilateral Renal Anomaly: Case Report

BACKGROUND: Hemivaginal obstruction syndrome and ipsilateral renal anomalies are known as Herlyn-Werner-Wunderlich syndrome (HWWs) or better known by the acronym obstructed hemivagina and ipsilateral renal anomaly (OHVIRA). It occurs as a result of complete failure of the Müllerian ducts to fuse and accounts for about 5% of Müllerian duct anomalies. Initial manifestations usually appear as a result of secretions accumulating within the hemivaginal obstruction. Patients with HWWs can come with complaints of lower abdominal pain, severe dysmenorrhea, pelvic or vaginal mass, abnormal vaginal discharge, acute urinary retention, fever, or vomiting. Therefore, careful diagnosis and appropriate management of this condition are desirable. The objective of the study was to report on the management of the obstruction due to HWWs. Patient was suspected hematocolpos with uterus didelphys from ultrasound and suggested right renal agenesis from BNO IVP. Diagnosis then confirmed by laparoscopy diagnostic. CASE REPORT: A 12-year-old patient was admitted to the gynecology ward of Dr. M. Djamil Central General Hospital from polyclinic with abdominal pain since 4 months before being admitted to the hospital. The pain gets worse every day before menstruation and decreases when given painkillers. CONCLUSION: OHVIRA syndrome is a triad characterized by hemivaginal obstruction and agenesis of the ipsilateral kidney (OHVIRA) and uterus in the delphys. Clinical symptoms in general are cyclic dysmenorrhea, palpable mass due to accumulation of menstrual flow, and severe pelvic pain which can later develop into a persistent form as a result of prolonged retention of menstrual secretions and obstructed hemivagina. Management options are surgical resection of the obstructed vaginal septum and drainage.

Possibilities of Early Ultrasound Diagnostics of the Herlin — Werner — Wunderlich syndrome (Case Report)

Herlin — Werner — Wunderlich syndrome or OHVIRA (Obstructed hemivagina and ipsilateral renal anomaly) is a rare type of uterine and vaginal doubling defect (0,1 – 10,0 % of all uterine abnormalities) which is characterized by a triad of symptoms: uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal dysgenesis. The manifestation of the disease usually present after menarche, is accompanied by severe pain syndrome, leads to redoubted complications and organ-carrying operations with decreasing the fertility. At an earlier age, it can manifest itself as an infection of the genitourinary system. The diagnosis is based on clinical and anamnestic data using instrumental methods, the most accessible and safe of which is ultrasound. This article presents three clinical cases of patients 5 – 6 years old with a description of the ultrasound picture of the OHVIRA syndrome.

Experiences Replay Accompanies Efficient Non-Local Learning: MEG Neurocomputational Dynamics

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare diagnosis; patients classically present with dysmenorrhea and increasing pelvic pain. Unusual manifestations of OHVIRA syndrome might occur as a result of patient anatomy and the rupture or relief of the obstructed hemivagina.We present a 15-year-old patient with OHVIRA syndrome who developed a spontaneous cervicovaginal fistula and subsequently underwent hemihysterectomy.

Multiple variants of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome – one clinical center case series and the systematic review of 734 cases

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare female urogenital tract malformation. To present 10 patients with OHVIRA treated at the clinical center. To perform a systematic review of OHVIRA case series related to the prevalence of anatomical variants, surgical interventions and endometriosis, and to compare them with our case series. Medical records from 10 OHVIRA patients treated between 2016 and 2020 were retrospectively reviewed. For the systematic review, PubMed and Web of Science were used to search for relevant studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were strictly followed. The most common anatomical variant includes left obstructed hemivagina (50.7%) with isolated hematocolpos or hydrocolpos (55.9%), uterus didelphys (82.9%), and ipsilateral renal agenesis (92.2%). Vaginal septectomy was the most common surgical approach (86.5%). Hemivaginectomy (2.2%), hemihysterectomy (4.2%), or total hysterectomy (0.7%) were also performed in several patients. Some subjects required salpingectomy (3.3%) or oophorectomy (1.8%). 7.5% of patients, mainly infants, did not require surgery due to the spontaneous resolution of hydrocolpos. Endometriosis was fortuitously found in 13.6% of the selected cases who underwent laparoscopy or laparotomy. The most common variant of OHVIRA includes isolated hematocolpos and a thick vaginal septum between adjacent hemivaginas. Endometriosis was present in approximately 14% of OHVIRA patients, but this number is probably underestimated. Routine laparoscopy is not required. However, all patients need further monitoring due to a higher risk of endometriosis. Based on the analyzed studies and our case series, vaginal septectomy is a sufficient surgical technique to relieve symptoms and prevent possible complications in most OHVIRA patients.

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA): Early diagnosis, treatment and outcomes

ObjectiveTo describe and summarize the early diagnosis, treatment and outcomes of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA). MethodsData from patients with OHVIRA treated at the study centre over the last decade were analysed retrospectively, including demographic characteristics, symptoms, diagnosis, treatment and outcomes. Relevant published literature was also reviewed in this study. ResultsIn total, 11 cases were diagnosed with OHVIRA over the study period, ranging in age from 3 to 14 years (median 11 years). Four cases were asymptomatic, four had abdominal pain and three had urinary symptoms. All 11 cases underwent vaginoplasty. Ureteral bladder re-implantation (n = 1), dysplastic nephrectomy (n = 1), separation of labia minora adhesions (n = 1), perineoplasty (n = 1) and urethroplasty (n = 1) were performed. Cases were followed up for 2 months to 8 years (median 5 years) with good follow-up outcomes. ConclusionsBased on the cases in this study and the relevant literature, ultrasound appears to be an effective method for the diagnosis of OHVIRA. Experienced ultrasonographers are able to achieve a high corrected diagnosis rate. The differential diagnosis of OHVIRA should be considered by paediatric surgeons, urologists, emergency physicians and gynaecologists when they identify patients with didelphys uterus or renal agenesis. Early surgery can reduce the risk of potential genital tract infection and gynaecological complications.

45. Undiagnosed OHVIRA Presenting as Tubo-ovarian Abscess Managed With Interval Vaginal and Abdominal Drainage

<h3>Background</h3> Obstructed hemi-vagina and ipsilateral renal anomaly (OHVIRA) typically presents with pelvic pain after menarche due to outflow obstruction. We present a case of a 17-year-old girl with history of renal anomaly who developed fever and pain and was found to have a tubo-ovarian abscess (TOA) and OHVIRA, treated with antibiotics and vaginal and intra-abdominal drainage. <h3>Case</h3> A 17-year-old female presented with fevers, abdominal pain, vomiting and diarrhea. She had menarche at age 11, and history of obesity, hearing loss, and right nephrectomy for unilateral congenital kidney disease. She denied prior sexual activity. At an outside hospital, she was diagnosed with rhinovirus and had a white blood cell count (WBC) of 27 × 10(3)/mcL. On exam, she had abdominal tenderness and a suspected oblique vaginal septum. MRI imaging confirmed the diagnosis of OHVIRA with 12 × 7 × 5 cm tubo-ovarian abscess and she was transferred to our tertiary care pediatric hospital. She was started on doxycycline, metronidazole, and piperacillin-tazobactam, but had persistent pain and was taken to the operating room for exam under anesthesia and drainage. We noted purulent vaginal discharge and a palpable right vaginal wall bulge which was incised, revealing purulent fluid. A 24 French Malecot drain was placed through the vaginal septum incision. She continued to have pain and WBC of 20 × 10(3)/mcL. Interventional radiology performed ultrasound-guided drainage and placed two transabdominal pigtail catheters into the TOA. Both vaginal and abdominal catheters drained purulent fluid, with gram negative and positive rods on gram stain, no growth on culture. Due to persistent pain and high WBC, she then underwent diagnostic laparoscopy/washout which showed uterine didelphys, normal left fallopian tube and ovary, and persistent right tubo-ovarian abscess, which was copiously irrigated and suctioned. Postoperatively, pain resolved and WBC normalized. Abdominal drains were removed and she was discharged home with norethindrone for menstrual suppression and oral doxycycline and metronidazole, followed by prophylactic doxycycline until definitive vaginal septum resection. <h3>Comments</h3> Obstructed hemi-vagina and ipsilateral renal anomaly (OHVIRA) is a Mullerian anomaly typically presenting with worsening dysmenorrhea +/- a pelvic mass. This patient had never been sexually active, had negative STI testing, and had menstruated for six years. We suspect she may have had microperforation in her septum allowing for both a path for ascending infection and delayed presentation of OHVIRA due to menstrual outflow. While patients with OHIVRA often undergo vaginoplasty at time of diagnosis, she required staged intervention due to elevated risk of infectious complications.

Resection of Vaginal Septum in Obstructed Hemivagina and Ipsilateral Renal Anomaly: Utility of Three Dimensional Intraoperative Ultrasound

Background: Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare congenital condition of the female urogenital tract, presenting intraoperative challenges. We demonstrate the utility of three dimensional intraoperative ultrasound to better delineate anatomy and aid in optimal resection of the vaginal septum. Case: A 12-year-old female was referred to pediatric and adolescent gynecology for irregular periods and evaluation of her gynecologic organs. Imaging studies confirmed OHVIRA syndrome. She underwent uncomplicated vaginal septum resection, guided by three dimensional intraoperative ultrasound. Summary and Conclusion: Intraoperative ultrasound can better delineate challenging anatomy. We show that three dimensional intraoperative ultrasound offers significant advantages over traditional two dimensional ultrasound and is a supplement to MRI, which may be helpful in complex anatomical cases like OHVIRA syndrome.