A Case Of Mullerian Duct Anomalies
- Menstrual cycle 5/30, average flow
severe dysmenorrhea
Rescan by Senior
Radiologist
- Uterus didelphus with unilateral
obstructed hemi-vagina forming
unilateral hematocolpos
- Right kidney: pelvic & hypoplastic
Left kidney: hydronephrotic
CT abdomen & pelvis advised
- Right kidney not visualized
Likely obstructed right uterine cavity
and cervix leading to dilated hemi-vagina
- A large pelvic mass 10X9X8.5 cm in RIF
pushing the uterus but origin was not identified
- Right kidney: absent
- Left kidney: hydronephrotic
- Counselling
- Written informed consent
- Anaesthesia fitness
- Examination under anaesthesia
- Blood group : O positive
- Haemoglobin : 11.2 g/dl
- TLC : 8.7x103/mm3
- Platelet count : 321 X103/mm3
- RBS : 80 mg/dl
- Vulva normal looking with intact hymen
- Bulge in right vaginal wall noted
- One normal-looking cervix identified
on the left side
- About 200 ml chocolate colored fluid drained
- Second cervix visualized through
another vaginal lumen
- Edges of opening marsupialized
- Urine R/E : Normal
- Clotting Profile : Normal
- LFTs : Normal
- RFTs : Normal
Obstructed hemi-vagina
& ipsilateral renal anomaly
(OHVIRA)
Herlyn-Werner-Wunderlich syndrome
- Uneventful
- Follow up visits
- Subsequent menstrual cycles normal
- Ultrasound revealed no evidence of collection of fluid in uterus
- Flat with central umbilicus
- gridiron scar of appendectomy
- A mass of 4x4cm in palpable in RIF, which was firm, non tender,having regular margins and its
lower limit was not accessible
General Physical
Examination
Normal looking
Intact, no bulge seen
Not done
Past Medical History
Not significant
Past surgical History
H/O appendectomy - 5 months back
- Pulse 92/min
- BP 100/70 mmHg
- Temp afebrile
- Pallor -ve
- Jaundice –ve
- Cyanosis –ve
- Edema –ve
- Thyroid not enlarged
- Lymph nodes not palpable
Personal History
- Associated complaints of lower abdominal mass increasing in size with menstruation for 3 months.
- No history of urinary & bowel complaints, fever, weight loss, anorexia.
- Visited private clinic in Oct 2015 where ultrasound abdomen revealed lower abdominal mass.
- Readmitted in SU-I in Nov 2015 with persistent complaints &referred to GU-I, on USG and ct scan findings
Name: Miss ABC
Age: 13 yrs
Marital status: Unmarried
R/O: Tarnol
M.O.A: Referred from SU-I
D.O.A: 4th Jan 2016
Dr. kiran bashir
PGR gynae
unit-I HFH
PresentingComplaints
Family History
not significant
Personal History
student of 7th grade
Socioeconomic History
middle class family
History of Present Illness
- Cyclical Lower abdominal pain:5months
- Heaviness and dragging sensation lower abdomen: 3 months
- Lower abdominal swelling: 3 months
- Sudden severe lower abdominal pain with nausea before attaining menarche in July 2016
- Appendectomy done in SU-I
- Uneventful intra operative and post operative course
- 1st menstruation 3 days after surgery was normal
- Asymptomatic and amenorrheic for 2 months (Aug & Sep)
- 2nd menstruation in Oct 2015 & since then she had cyclical lower abdominal moderate pain non radiating,increasing in intensity with menses