Delayed Diagnosis of Herlyn-Werner-Wunderlich Syndrome due to Microperforation and Pyocolpos in Obstructed Vaginal Canal

Woźniakowska, Ewa; Torres, Anna; Milart, Paweł; Woźniak, Sławomir; Czuczwar, Piotr; Szkodziak, Piotr; Paszkowski, Tomasz

doi:10.1016/j.jpag.2013.07.009

Cited by 17 publications

(21 citation statements)

References 6 publications

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“…Hematocolpos and hematometra are more prevalent at the right side and result from retained menstrual flow. These manifestations are more painful when the vaginal septum fuses with the vaginal wall, leading to a complete obstruction [1,2,20,25]. If there is not a complete obstruction, symptoms may delay or be only mild [12].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…In these cases, two vaginal openings are present and patients are frequently asymptomatic and only incidentally detected [25]. These vaginal duplications are commonly mistaken for HWWS, but actually do not belong to the typical presentation [13].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Several reasons may justify the delayed symptoms: first, due to its distention proprieties, the vagina can accommodate a large volume of blood; second, some of the blood is absorbed between menses [23]; third, anti-inflammatory drugs and oral contraceptives are usually prescribed to relieve dysmenorrhea [2,26]; and finally, some patients presenting with isolated vaginal discharge are erroneously treated with long-term antibiotics. At the emergency department, the diagnosis is also challenging and frequently simulates inflammatory and infectious disorders like tubo-ovarian abscess [25].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…These patients tend to present with purulent vaginal discharge [1,25]. Peritonitis is a rare acute complication and occurs when hematocolpos progress to hematosalpinx and rupture [12].…”

Section: Complicationsmentioning

confidence: 99%

“…2, 3) [25]. Some surgeons prefer to perform the vaginal septum resection only after a large hematocolpos develops.…”

Section: Treatmentmentioning

confidence: 99%

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Herlyn–Werner–Wunderlich syndrome: pre- and post-surgical MRI and US findings

Dias

Jogo

2015

Abdom Imaging

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Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare congenital anomaly of the female urogenital tract that associates Mu¨llerian duct anomalies with mesonephric duct anomalies. The triad of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis characterizes this syndrome. Patients generally present with non-specific symptoms after menarche. Pelvic pain, dysmenorrhea, and palpable mass due to hematocolpos or hematometra are the most common findings. Pyohematocolpos and pyosalpinx may appear as acute complications, while endometriosis and pelvic adhesions constitute potential long-term complications. When a prenatal diagnosis of unilateral renal agenesis in newborn girls is known, a gynecological imaging study should be performed to exclude uterine and vaginal abnormalities. These patients should be followed up to ensure that a timely surgical correction is performed. The diagnosis of HWWS is difficult due to the lack of specific symptoms or findings upon physical examination. An accurate imaging description of these congenital anomalies is crucial to guide patients toward surgical treatment, relieving acute complications, and preserving the normal fertility. The authors provide a pictorial review of the magnetic resonance imaging and ultrasonography findings of the HWWS with correlation to embryological, clinical, and surgical features.

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Section: Clinical Presentationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

“…These patients tend to present with purulent vaginal discharge [1,25]. Peritonitis is a rare acute complication and occurs when hematocolpos progress to hematosalpinx and rupture [12].…”

Section: Complicationsmentioning

confidence: 99%

“…2, 3) [25]. Some surgeons prefer to perform the vaginal septum resection only after a large hematocolpos develops.…”

Section: Treatmentmentioning

confidence: 99%

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