Obstructed Vagina Research Articles

Hematocolpos in women with uterus didelphys, imperforate hemivagina and ipsilateral renal agenesis: A case report and review of the literature

Introduction and importanceHematocolpos can be part of a rare syndrome OHVIRA or Herlyn-Werner-Wunderlich syndrome that requires special management (Brousse et al., n.d. [1]). The diagnosis can be delayed, yet an early diagnosis is important in order to elaborate an adequate strategy management and prevent the patient from complications.Case presentationWe report the case of a 14-year-old girl suffering from an hematocolpos due to this syndrome who has underwent a surgery in our hospital.Clinical discussionHematocolpos, the main symptom, is due to a retention of retained menstruation blood in women with obstructed hemivagina. Therefore, it's painful and associated with increasing dysmenorrhea (Brousse et al., n.d. [1]). The main treatment consists in its drainage with resection of vagina septum, preventing the patient from complications like endometriosis, infection, and infertility.ConclusionA good knowledge of this anomaly can lead to an adequate diagnosis and more importantly an adequate treatment based on surgery to prevent the bad outcomes.

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.

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 MRI to improve the delineation of gynecologic anatomy, and to recommend that this modality be considered in patients with complex müllerian anomalies. OHVIRA is a unilateral obstructed müllerian anomaly that can be definitively treated with resection of the obstruction. When the obstructed hemivagina is within close proximity to the patent hemivagina, vaginal septum resection should be performed. However, when the obstructed hemivagina and uterus are not adjacent to the patent hemivagina, the risk of post-resection stenosis is increased due to the thickness of the obstructing tissue. Laparoscopic removal of the obstructed side should be considered as an alternative approach. In the presented case, a 17-year-old patient with OHVIRA presented for definitive surgical management. A pelvic MRI was performed, but due to 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 was feasible, norethindrone was discontinued to allow menstrual blood to fill the obstructed hemivagina, followed by a subsequent pelvic MRI with aqueous vaginal contrast gel to improve the visualization of the decompressed vaginal cavities. 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 had a <1 cm narrow segment adjacent to the patent vagina, and the obstructed cervix was superiorly displaced 3.5 cm above the patent vagina. Given these findings, the risk of post-operative stenosis following a vaginal septum resection was determined to be too high. The decision was made to proceed with a laparoscopic resection of the obstruction, and a laparoscopic resection of the right hemiuterus, fallopian tube, cervix, and vagina was performed. The patient recovered without complication post-operatively, 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 is advantageous to clearly delineate the course and caliber of the patent vagina. Second, the cessation of hormonal suppression to allow menstruation to develop hematocolpos helped delineate the relationship between the obstructed vagina and the patent vagina. 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 risk for post-operative stenosis in this patient.

Herlyn–Werner–Wunderlich syndrome: diverse presentations and diagnosis on MRI

To evaluate the diverse presentations of Herlyn-Werner-Wunderlich (HWW) syndrome on magnetic resonance imaging (MRI) and its surgical correlations. From 2014 to 2019, a total of 40 patients with HWW syndrome underwent pelvic MRI. All MRI images were reviewed by two experienced radiologists in consensus. Uterine anomalies, obstruction sites, laterality and communications, urinary anomalies, and other abnormal findings were recorded. MRI findings were correlated with ultrasonography and surgical results. On MRI, the uterus was didelphic in 25 (62.5%), septate in nine (22.5%) and bicornuate in six cases (15%); an ipsilateral vaginal septum was found in 30 cases (75%), and ipsilateral cervical obstruction (obliterated cervical os) was found in 10 cases (25%). Twenty-seven patients underwent surgical treatment. MRI diagnoses of obstruction sites correlated completely with the surgical results. Although obstruction communications could not be found with ultrasonography, MRI identified nine cases of cervical communication, but failed to detect the five cases of surgically confirmed fistula on the vaginal septum. Moreover, MRI identified nine cases of ipsilateral ureteral remnants and/or paravaginal cystic structures, all with insertion into the obstructed vagina or cervix, and one case of ipsilateral ureterocele. HWW syndrome can present as different combinations of uterine anomalies, unilateral cervico-vaginal obstruction, and ipsilateral renal anomalies; ipsilateral paravaginal cystic structures and/or ureter remnants inserting into the obstructed vagina or cervix can occasionally be seen. MRI can provide a comprehensive preoperative evaluation and better identification of obstruction sites, but seems insensitive for detecting vaginal communications in HWW syndrome.

Herlyn‐Werner‐Wunderlich syndrome with cervical atresia complicated by ovarian endometrioma: A case report

Herlyn-Werner-Wunderlich syndrome (HWWs) is a rare congenital malformation that involves uterus dideslphys, obstructed hemivagina and ipsilateral renal agenesis. The obstructed vagina affects menstrual flow and causes related clinical features after menarche. Pelvic endometriosis is one of the common complications of HWWs. Resection of the vaginal septum can release the obstruction and result in good outcomes. However, in the case of cervical atresia, a rare variant of HWWs, ipsilateral hysterectomy is recommended because it is difficult to canalize cervical atresia surgically. Here we present a case of HWWs with cervical atresia complicated with pelvic endometriosis. She was treated with laparoscopic ovarian cystectomy followed by hormonal therapy. Six months after surgery, there is no evidence of recurrence of endometrioma.

Uterus Didelphys with an Obstructed Unilateral Vagina by a Transverse Vaginal Septum Associated with Ipsilateral Renal Agenesis: OHVIRA Syndrome − An Unusual Case Report and Review of Literature

The triad of uterine didelphys, obstructed hemivagina, and unilateral renal agenesis, called as OHVIRA syndrome is the least common of all Mullerian malformations. We report a case of a 16-year-old girl who presented with lower abdominal pain and amenorrhea. Radiological investigations led us to the diagnosis of OHVIRA syndrome. She was hospitalized and operated upon. OHVIRA syndrome, though a rare Mullerian anomaly, should be kept as a differential diagnosis in a young girl presenting with cyclical pain and amenorrhea with renal agenesis so that surgical management can be performed before long-term complications set in.

Radiological Manifestations of Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome: A Rare Complex Müllerian and Wolffian Duct Anomaly

AbstractObstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare complex Müllerian and Wolffian duct anomaly. It is also known as Herlyn–Werner–Wunderlich syndrome (HWWS). It includes unilateral renal anomalies and uterine didelphys. It generally occurs at puberty and exhibits non-specific and variable symptoms with acute or pelvic pain shortly following menarche, causing a delay in the diagnosis. We report here a 16-year-old female presenting with progressive cyclical pelvic pain, where magnetic resonance imaging (MRI) suggested the diagnosis of the OHVIRA syndrome. She was managed by surgical resection of the septum and draining of the obstructed vagina.

Left Vaginal Obstruction and Complex Left Uterine Horn Communication in a 12 Year Old Female

Obstructive Mullerian duct anomalies are an infrequently encountered clinical problem. The use of imaging and surgical exploration allowed for diagnosis and treatment of symptoms of a complex obstructive mullerian anomaly. We present a case of a 12 year old female with a history of intermittent lower abdominal pain and absent left kidney who was found to have an obstructed left vagina and complex left uterine horn communications resulting in hematocolpos, hematometra, and endometriosis.

Extended Use of Percutaneous Obstructed Vagina Access (POVA) Technique for Safe Entry Into Pyo/Hematometrocolpos

Extended Use of Percutaneous Obstructed Vagina Access (POVA) Technique for Safe Entry Into Pyo/Hematometrocolpos

Herlyn-Werner-Wunderlich Syndrome: Merits of Sonographic and Magnetic Resonance Imaging for Accurate Diagnosis and Patient Management in 13 Cases

Study ObjectiveTo review the main sonographic and magnetic resonance imaging manifestations of Herlyn-Werner-Wunderlich syndrome, characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis, and to discuss the value of techniques for its diagnosis and treatment. ParticipantsThirteen patients with Herlyn-Werner-Wunderlich syndrome referred to our department with acute abdomen were identified for the period from 2009-2012. DesignRetrospective chart review. SettingTwo tertiary academic centers. InterventionsNone. Main Outcome MeasuresThe evaluation of the clinical features, ultrasonography and magnetic resonance imaging findings, and the treatment protocols. ResultsUltrasonographic evaluation of didelphic or double uterus in 10 and bicornuate-bicollis uterus in 3 patients with hematocolpos or hematometrocolpos associated with agenesis of the ipsilateral kidney revealed the diagnosis. In 10 patients, magnetic resonance imaging provided extra information. In 1 patient, a 25-week pregnancy was additionally detected and follow-up was suggested. Seven patients underwent surgical excision of the septum and drainage of the obstructed vagina. Total hysterectomy and hemicolpectomy were performed in 1 patient with 2 children suffering from severe chronic pelvic pain due to pelvic inflammatory disease. ConclusionsDespite its rarity, accurate diagnosis and morphologic description of Herlyn-Werner-Wunderlich syndrome with radiologic modalities are of importance in relieving the clinical complaints by enabling the suitable surgical treatment to be identified.

Management of Lower Vaginal Agenesis in a Patient with Unicornuate Uterus

BackgroundAbsence of the lower vagina occurs from abnormal development of the sinovaginal bulbs and vaginal plate. CaseWe present a case of an adolescent girl, with a history of VACTERL and VATER status post flap vaginoplasty at 8 m of age and correction of vaginal-urethral fistula, with primary amenorrhea and cyclic pelvic pain. MRI showed a right hematocolpos. On exam the obstructed vagina was deviated to the right. Given prior urologic and rectal surgery, and laterality of unicornuate system, intra-operative ultrasonography (US) was performed. A needle was used to enter the inferior aspect of the obstructed vagina. A pull-through vaginoplasty was performed. Summary and ConclusionVaginal pull-through is the standard treatment for lower vaginal agenesis. In a unicornuate system, the use of intra-operative US is helpful to determine the appropriate angle of dissection.

Management of Lower Vaginal Agenesis in a Patient With Unicornuate Uterus

Management of Lower Vaginal Agenesis in a Patient With Unicornuate Uterus

Obstruction of Hemivagina Without Ipsilateral Renal Agenesis in Septate Uterus

through procedure at an OSH via a sagittal incision for treatment of the imperforate anus. A small vagina was identified high on the right which was found to be “short” and connected to a “short uterus” with an associated tube and ovary. It was surgically lengthened with flaps from the labia and connected to the introitus. A small fistula going from the vagina to a ureteral remnant from a dysplastic kidney was identified, divided, and ligated. She subsequently did well. Signs of pubertal development were evident at age 10 e 11, with normal breast development and accelerated growth; however, menarche was absent. At age 14, she presented for evaluation of primary amenorrhea and pain. Ultrasound identified two uterine horns, a right ovary, and a distended fluid filled vagina. MRI showed a hematocolpos which appeared contiguous with the right corpus and tube. Left rudimentary uterine corpus and tube were not fluid filler. A re-do vaginoplasty was planned. EUA demonstrated extensive scar tissue with a stricture at 1.5cm from the introitus. Given the history of prior urologic and rectal surgery, and the fact that her unicornuate system was not midline, intra-operative ultrasound was used to identify the inferior aspect of the hematocolpos. With ultrasound guidance a long spinal needle was advanced until it was noted to enter the inferior aspect of the obstructed vagina (Figure 2). Once the angle and direction of dissection was determined, electrocautery was used to carry the dissection upwards. The intervening tissue was excised and 900cc of old blood was evacuated. Vaginal mucosa was identified and a standard pull through vaginalplasty was performed. Vaginal pull through is the standard treatment for lower vaginal agenesis. With a single midline uterus, cervix and upper vagina, the distal aspect of the obstructed upper vagina can be identified by palpation, and

Primary vaginal calculus secondary to urethrovaginal fistula with imperforate hymen in a 6-year-old girl

Primary vaginal stones are extremely rare in children and may be mistaken for bladder calculi on plain radiography. We present a case of a large vaginal calculus in a 6-year-old girl who had an imperforate hymen and urethrovaginal fistula. Hymenotomy and urethrovaginal fistula repair were performed, and the vaginal stone was extracted. It was postulated that the vaginal calculus originated from stasis of urine through the urethrovaginal fistula in the obstructed vagina. This is a unique case of a vaginal calculus with a congenital urethrovaginal fistula associated with an imperforate hymen.

A case of didelphic uterus and blind hemivagina with renal dysplasia and ectopic ureter presenting with vulvodynia and recurrent fever

Didelphic uterus with blind hemivagina and ipsilateral renal anomaly is a rare congenital malformation. The pathogenesis of this syndrome and its embryologic origin are still the subject of discussion. Due to the variable clinical picture and low index of suspicion, diagnosis is often delayed or inaccurate. Conservative surgical treatment—excision of the obstructing vaginal septum and marsupialization of the blind hemivagina—is considered the most appropriate treatment. This report describes the case of a 16-year-old girl with didelphic uterus and double vagina, with obstruction of the left hemivagina. The patient was also diagnosed with left renal dysplasia and ipsilateral ureter communication with the obstructed vagina. Following various examinations and left uretero-nephrectomy, the patient was effectively treated with resection of the vaginal septum.

Imperforate vagina in the newborn. Neonatal hydrocolpos.

anot uncommoncomplication ofimperforate vagina in thenewborn. We donotpropose todiscuss the relatively commonproblem ofvaginal occlusion duetolabial adhesions (Fig. 1),whichcanbe easily separated withlittle ornobleeding. Hydrocolpos inthenewborn femaledueto imperforate hymenortoocclusion byamembrane inthelowerthird ofthevagina isnotexcessively rare.Atorshortly after birth theinfant presents withlower abdominal swelling andabulging membraneisseenatthevaginal orifice (Fig. 2).This bulging membrane looks like acystocele andwhen gently reduced theurethral orifice canbeseen anteriorly. Occasionally theremay be a tiny opening intheoccluding membrane through which a whitemucoidmaterial canbeextruded. The anomaly hasbeenfully described byMahoney andChamberlain (1940), byGross(1953), byCaffey (1956), andbymanyothers andforthepurposes ofthepresent communication a brief description oftheir findings will besufficient. Inthis condition thevagina isinvariably greatly distended-hydrocolpos-and onoccasions theaccumulated fluid canstretch thecervical canal andthe bodyoftheuterus aswell-hydrometrocolposthough wehaveseentheuterine cavity distended onlyononeoccasion. Theballooned genital tract arises fromthepelvic floor intotheabdominal cavity. Thecyst isfilled withclear ormucoid fluid whichtendstobecomepurulent frombacterial invasion, giving risetopyocolpos. Theuterine tubes havenotbeeninvolved inanyofthereported cases. The distended genital tractmay cause urinary obstruction andtheenlargement ofthe bladder mayhinder palpation ofthevaginal cyst. Megaloureter andhydronephrosis mayfollow and pyuria willbea further complication. Posterior pressure maycause rectal obstruction. Theremay * A paperreadatameeting oftheBritish Association ofPaediatric Surgeons heldinLondoninJuly1960. berespiratory embarrassment through theupward displacement of theabdominal contents. On digital rectal examination thepelvis isfilled bya massprojecting against thehollow ofthesacrum. On inspection ofthevagina abulging membrane isseenatorabovethehymen.Insuchpatients a needle isinserted through themembraneandfluid isaspirated toconfirm thediagnosis. Radioopaquefluidmay be instilled to outline the obstructed vagina(Fig.3).Havingmadethe diagnosis theoccluding membraneisslit witha knife andthecystcontents areevacuated. Lesscommonly thehydrocolpos isduetoatresia ofthelower vagina (White andDennison, 1958) and

Two Cases of Obstructed Vagina

Two Cases of Obstructed Vagina

Case of Obstructed Vagina: With Remarks

Case of Obstructed Vagina: With Remarks