Incidental diagnosis of Herlyn-Werner-Wunderlich Syndrome in a nulliparous woman: a case report in Bhutan

Abstract

Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare congenital syndrome with features of uterus didelphys, ipsilateral absent kidney and obstructed hemivagina. Ultrasound findings of absent kidney or abnormalities in the kidney should alert the clinicians about the syndrome. Complications like endometriosis, infertility and pelvic inflammation occurs with late diagnosis.A 42-yearold nulliparious married woman who presented with right sided abdominal pain to the National Referral Hospital was diagnosed to have HWWS. The diagnosis was supported by ultrasound, CT and MRI findings. Patient was treated for endometriosis and had symptomatic improvement. The diagnosis of the syndrome is challenging as it is rare but clinicians should suspect the syndrome in women who present with infertility. Ultrasound scan is the basic investigation to screen the syndrome which is available in most hospitals.

Uterus didelphys with double vagina diagnosed during third cesarean section: A case report

“…There are reports of association of HWWS with pelvic endometriosis. 18 Among 16 cases of obstructing malformations of the uterus and vagina operated at The Children's Hospital, Harvard Medical School, between 1970 and 1983, one case had her kidneys in normal position. 19 Similar to our case, there are case reports of successful term singleton as well as twin pregnancies elsewhere.…”

“…There are cases where uterine anomalies were missed during laparotomy. 18,23 Undiagnosed uterus didelphys risks uterine rupture in future if a trial of vaginal birth is planned. As reported in the literature, pregnancy in one horn of the uterus may be confused with cornual ectopic pregnancy, 7 and it might mimic ovarian tumor.…”