Acute abdomen: Unusual presentation of Herlyn-Werner Wunderlich syndrome

Abstract

Introduction and importance The presentation of an acute abdomen has a wide range of differentials. Developmental anomalies are rarely considered as part of the clinical reasoning process due to it being a mimicker of other commoner diseases. The importance of considering such anomalies and recognizing them early is essential in order to prevent complications, such as infertility. Case presentation Our case report presents an approach to a female of pediatric age complaining of right lower abdominal pain mimicking appendicitis. The physical examination and clinical findings were also in line with appendicitis. Thus, the initial work-up focused on that as the top differential. Due to the patient being female, other work-ups were conducted in order to rule out gynecological conditions such as a pelvic ultrasound. The ultrasound findings changed the approach, warranting a CT and MRI. The subsequent diagnosis was Herlyn-Werner-Wunderlich Syndrome. Intervention involved incision and dilation of the vaginal septum as it is the most effective and least traumatic method. On follow-up, the patient's symptoms resolved. Clinical discussion Rare diseases can mimic common diseases. Clinically, findings of other work-ups indicated a completely different diagnosis than originally suspected. Clinical reasoning thus shifted the focus to another approach and intervention. Conclusion Clinical features of appendicitis, a clinical diagnosis, were most evident. An inappropriate management may have ensued if investigations were not conducted. Ultimately, the case report illustrated the importance of radiological investigations in an acute abdomen.

Herlyn Werner Wunderlich Syndrome with Hydrocolpos: A Case Report

“… 2 , 4 , 7 Some cases has also been reported where patient presented with acute urinary retention, septic shock and acute abdomen mimicking acute appendicitis. 9 In our case, patient presented with pain over right flank since 4 days with hydrocolpos as a cause of symptom rather than hematocolpos. If the case is not diagnosed and treated on time, patients present with more serious complications like pyocolpos, pyosalpinx, peritonitis and tuboovarian abscess.…”

“…USG is non invasive, fast and first investigation of choice which shows renal agenesis, two distinct uterine cavity and a cystic fluid collection in hemivaginal canal. 9 , 10 MRI can be done further delineate the anatomy of uterus, vagina, kidney and to characterize the fluid collection. It can also detect associated complications like endometriosis, adhesions and pelvic inflammation.…”

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

“…To our knowledge there are three cases with OHVIRA syndrome reported in the gulf region, two from Saudi Arabia [18,19] and one from Bahrain [20]. One underwent a laparoscopic right hemivaginal drainage for hematocolpos and vaginal septotomy, whereas there were no details on the surgical intervention in the other two cases.…”

Unusual clinical presentations, pathogenesis and radiological review of Herlin-Werner-Wunderlich syndrome: A case report and literature review

“…Another case of a 13-year-old girl with imperforated hymen resulting in hematometrocolpos is reported in which she had cyclic lower abdominal pain and constipation for which she was self-medicating with anti-helminthic medications [15] . In another young female of the pediatric age group, the HWW syndrome was manifested with right lower abdominal pain and tenderness simulating acute appendicitis [16] . Furthermore, several other cases of HWW syndrome were reported in pediatric and early adolescent age group patients complaining of acute abdominal pain [17] , [18] , [19] .…”