Herlyn-Werner-Wunderlich syndrome: A rare cause of abdominal
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Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital disease characterized by Mullerian duct anomalies. The characteristic triad of this syndrome includes didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis.

Sixteen-year-old sexually active female, with no relevant past medical or surgical history, presented with acute onset of worsening left lower abdominal pain of 3-4 days duration. She also reported dyspareunia, post coital bleeding, and occasional hematochezia. Physical examination revealed mild lower abdominal tenderness without rebound or guarding.

Imaging findings

Recent previous CT scan from a different institution showed absence of left kidney, a low attenuation lesion (1.9 × 3.0 × 3.9 cm) with punctate calcification in the left renal fossa, and no colon or bowel pathology.

Pelvic ultrasound was obtained for further evaluation which showed normal ovaries bilaterally, a tubular structure in the left adnexal region with thickened walls and surrounding hypervascularity, and a duplicated uterine cavity. The absence of left kidney was noted.

Subsequently, MRI of the abdomen and pelvis was obtained which demonstrated complete duplication of the uterine horns, endometrial cavities, and endocervical canal consistent with uterine didelphys. A cystic structure just distal to the left endocervical canal likely represented an obstructed left hemivagina. A collapsed right hemivagina was seen communicating with the right endocervical canal.

Source: Radiology case reports

Read more: https://www.sciencedirect.com/science/article/pii/S1930043319302663