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