Obstructed Left Hemivagina Research Articles

Surgical management of 12-year-old with complete septate uterus with duplicated cervices and obstructed left hemivagina: A case report

Introduction: When a patient with an obstructed hemivagina presents in childhood, either hormonal suppression or a staged procedure is proposed for management of the obstruction. Case Report: This case report is a 12-year-old patient presenting for evaluation of hematocolpos with a complete septate uterus, duplicate cervices, bilateral kidneys, and obstructed left hemivagina who was surgically managed with a complete vaginal septum resection and hysteroscopic metroplasty in one procedure shortly after diagnosis. Conclusion: This anomaly is not only rare, and the first presented in the literature, but it also importantly demonstrates that if desired by the family after a consideration of benefits and risks, resection of both vaginal and uterine septa can be safely performed in a young post-menarchal patient without the need for a staged procedure later in life.

OHVIRA-syndrome in a newborn

OHVIRA-Syndrome (Obstructed hemivagina with ipsilateral renal anomaly) is a rare congenital malformation. Diagnosis of this malformation is usually made during adolescence. Delayed diagnosis may result in serious complications with potential future obstetric problems. We report on a newborn girl presenting with an interlabial mass formation, a vaginal introitus on the right lateral aspect and an orthotopic urethral meatus on primary inspection. Ultrasound examination revealed left sided renal agenesis and a hydrocolpos posterior to the bladder. OHVIRA-Syndrome was assumed and a surgical incision of the obstructed left hemivagina for drainage of the hydrocolpos was performed. Further examination confirmed anatomical conditions corresponding to OHVIRA-Syndrome. Aside from routine clinical follow-up and regular ultrasound examination, further interventions were postponed until puberty. In this case report we aim to share our experience of a newborn girl with OHVIRA-Syndrome. We discuss appropriate medical decision-making regarding surgical management of patients with this malformation during each stage of development with a corresponding literature review.

27. A Case of Vaginal Yolk Sac Tumor in an 8 Year Old Girl with Didelphys Uterus

<h3>Background</h3> Vaginal yolk sac tumors are quite rare in children. They usually occur in young girls under the age of 3 and present with vaginal bleeding. We present a case where an initial exam under anesthesia revealed no evidence of a vaginal malignancy. However, due to ongoing symptoms, a re-evaluation revealed vaginal yolk sac tumor which had been concealed by a congenital anomaly. <h3>Case</h3> An 8 year old girl presented with a 3 month history of pre-pubertal vaginal bleeding. A workup revealed pre-pubertal hormonal levels, no evidence of vaginal infections or foreign objects and no concerns for sexual abuse. Imaging revealed a didelphys uterus with 2 cervixes and a 9mm collection of heterogeneous material which appeared to be within an obstructed left hemi-vagina. On vaginoscopy there was no visible blood, no distension of the left hemi-vagina that could be visualized, and no evidence of malignancy. Due to ongoing symptoms, exam under anesthesia was repeated in one year. On this exam a bulge was noted in the vagina. The vaginal septum was perforated and significant vaginal tumor was discovered within the left hemi-vagina. This was biopsied and found to be an extra-gonadal yolk sac tumor. She was subsequently referred to oncology and diagnosed with Stage III extra-gonadal yolk sac tumor with negative AFP. She received 4 cycles of cisplatin, bleomycin and etoposide (PEB). She underwent interval debulking of vaginal tumor, which was halted due to excessive bleeding from the tumor. She underwent 2 additional cycles of PEB followed by excision of the vaginal septum. At that time there was no further visible tumor and no tumor was identified on histologic evaluation of the septum. <h3>Comments</h3> This case illustrates difficulty diagnosing a vaginal tumor due to a congenital anomaly. It is critical to continue to follow patients with pre-pubertal bleeding if there is no etiology discovered initially. Though malignancy is a rare cause of pre-pubertal vaginal bleeding, it is important to reconsider this in cases which include congenital anomalies that may delay the diagnosis.

Uterine Didelphys with Obstructed Left Hemivagina with Haematometrocolpos: A Rare Congenital Cause of Lower Abdominal Pain in Young Female

Uterus didelphys is a very rare mullerian duct anomaly and is part of various congenital anomalies of female genital tract. We report a case of eighteen years old female presenting with lower abdominal pain and dysmenorrhorea diagnosed to have uterine didelphys with obstructed left hemivagina with haematometrocolpos on MRI and managed by excision of vaginal septum and relieved of symptoms.

Diagnosis and surgical management of Herlyn-Werner-Wunderlich syndrome

Abstract Abdominal pain in the adolescent population is rarely attributed to anatomic variance. Minimal consideration placed on this pathology can present a diagnostic dilemma and delay in care if such options are not investigated. Our case report describes the workup, step-by-step imaging and multidisciplinary approach to a twelve-year-old female who presented with abdominal pain at an outside facility, where she was originally diagnosed with a pelvic mass seeming to arise from the left ovary on ultrasound. Subsequent CT at the authors’ institution indicated a hydrometrocolpos and possible uterine and vaginal duplication; exam under anesthesia revealed uterine didelphys with obstructed left hemivagina. MRI confirmed the diagnosis of Herlyn-Werner-Wunderlich Syndrome and return to the operating room resulted in successful evacuation of the obstructed hemivagina by vaginal septum resection. Post-operatively, she is doing well, menstruating without difficulty, and has not had recurrence of symptoms. This case elucidates the need for consideration of Mullerian duct anomalies in female pediatric patients presenting with lower abdominal pain.

Uterus didelphys with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA syndrome): A case report

Abstract Uterus didelphys with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare congenital urogenital anomaly. We report a case of a 14-year-old female who presented with acute lower abdominal pain and tender pelvic mass. The initial diagnosis of twisted left ovarian cyst was confirmed by abdominal ultrasonography (US), which showed an associated absent left kidney. The findings at laparoscopy were that of uterus didelphys with obstructed left hemivagina. Parents were concerned about hymnal integrity and refused hemivaginal septal resection.

Herlyn Werner Wunderlich syndrome (HWWS): an unusual presentation of acute abdominal pain.

Herlyn Werner Wunderlich syndrome (HWWS): an unusual presentation of acute abdominal pain.

OHVIRA With a Twist: Obstructed Hemivagina Ipsilateral Renal Anomaly With Urogenital Sinus in Two Patients

The syndrome obstructed hemivagina ipsilateral renal anomaly (OHVIRA) is a rare diagnosis in females that involves a combination of the triad of obstructed hemivagina, uterine anomaly (usually uterus didelphys), and ipsilateral renal anomaly. Presentation with non-specific pelvic symptoms can delay diagnosis. The OHVIRA syndrome can be associated with other anomalies due to abnormal embryologic development of the urogenital system. We therefore present two patients who had OHVIRA syndrome complicated by a urogenital sinus. Case #1: A 14-y-o female with known absence of the left kidney and long-standing urinary incontinence presented with abdominal distention. Menarche was at age 12. An MRI revealed an obstructed left hemivagina and hemiuterus. Exam under anesthesia revealed a single orifice at the introitus. Cystoscopy revealed absence of the bladder neck; a separate vaginal opening could not be visualized. At exploration, the patient was found to have obstruction of a left hemiuterus and hemivagina and a small confluence of the right hemiuterus and hemivagina with the single opening on the perineum. She underwent reconstruction with enterocystoplasty, creation of a continent catheterizable channel and bladder neck closure. The obstructed left hemiuterus and hemivagina were removed and a vaginoplasty was performed to create patency for the right hemivagina. Case #2: A 4-y-o female with known absence of the right kidney and urinary incontinence was found on cystoscopy to have a single common channel at the introitus that communicated with the bladder and a hemivagina on the left. She underwent bladder augmentation with catheterizable channel and bladder neck closure, removal of a rudimentary hemiuterus on the right and vaginoplasty to establish patency of the left hemivagina with the common channel. OHVIRA is a rare congenital anomaly that can be associated with other developmental malformations. Our cases support the importance of identifying the presence of a urogenital sinus in the setting of the OHVIRA syndrome, as the surgical management for these patients may be affected. In both cases the urogenital sinus was preserved as the vaginal opening. Neither patient has required an introitoplasty.

Uterus didelphys with imperforate hemivagina and ipsilateral renal agenesis complicated by hematocolpos, hematometra and hematosalpinex. The challenge of intact hymen

Abstract Background Uterine didelphys with obstructed hemivagina is an extremely rare condition. This diagnosis should be considered whenever an adolescent is presented with severe dysmenorrhea and progressive pelvic mass. Case A 15-year-old girl presented with uterus didelphys with obstructed left hemivagina and ipsilateral renal agenesis. Excision of the septum was done using monopolar diathermy in the cutting mode under laparoscopic and hysteroscopic guidance, taking into consideration the integrity of the hymen. Complete recovery was achieved within one week. Conclusion The prompt and accurate diagnosis of this condition is essential to prevent complications from acute illness and to preserve future fertility. Ultrasonography, CT scan and MRI are the initial steps for its diagnosis; however, laparoscopy is a crucial tool for confirmation of the diagnosis. In order to avoid the associated morbidity of delayed management, surgical intervention should be considered as the first line therapy, taking into consideration the social and traditional backgrounds of the parents and patients.

Complete Septate Uterus with an Obstructed Left Hemivagina and Ipsilateral Renal Agenesis

Complete Septate Uterus with an Obstructed Left Hemivagina and Ipsilateral Renal Agenesis

Transvaginal sonography in the morphological and functional assessment of segmental dilation of the distal ureter

Primary megaureter presents a spectrum of findings ranging from mild, clinically unimportant, stable ureterectasis to severe, progressive obstructive hydroureteronephrosis. We report a patient with a double uterus and ipsilateral renal dystrophy. A previous imaging study had revealed a double uterus and obstructed left hemivagina, into which a single vaginal ectopic ureter inserted. On follow-up intravenous urography 8 years later, the left kidney was non-functioning, and there was segmental dilation of the distal right ureter. Transvaginal sonography with real-time scanning and Doppler were useful in exploring the morphological and functional status of this dilated distal ureter.

Successful Pregnancy in an Adolescent Woman with a Communicating Double Uterine Anomaly

Background: Women with communicating double uterine anomalies are at increased risk for obstetric complications, including early pregnancy loss, preterm delivery, and breech presentation. We present the pregnancy of a woman with a previously diagnosed communicating double uterine anomaly. Case: An 18-yr-old white female with a previous diagnosis at age 11 of a communicating double uterus, double cervix, and obstructed left hemivagina was followed during the course of her pregnancy. She experienced no complications until 36 6/7 weeks, when she was found to have signs and symptoms of mild preeclampsia. The fetus was in a breech presentation and a cesarean section was performed. Two hemiuteri were identified intraoperatively. The communication was not visualized. A viable male infant was delivered without complications. Conclusion: This patient represents only the sixth report of successful pregnancy in a woman with a Toaff type 5A communicating uterine anomaly.

Communicating double uterus with obstructed hemivagina and subsequent abscess formation: A case report

Background: Communicating double uterine anomalies are defined as müllerian defects which involve two hemiuteri with communication between the uterine halves. Nine subcategories of communicating uterine anomalies have been described; only two of these subcategories are associated with hemivaginal obstruction.Case: An 11-year-old white female was brought to the Emergency Department with fever and acute pelvic pain. This condition was found to be caused by abscess formation behind an obstructed left hemivagina with involvement of a communicating double uterine anomaly.Conclusion: To our knowledge, this is the first case report involving a communicating double uterine anomaly in which fever was a presenting symptom.