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A Case Of Mullerian Duct Anomalies

HISTORY

Gynecological History

  • Menarche 5 months ago

  • Menstrual cycle 5/30, average flow

severe dysmenorrhea

  • IMB -ve

  • Vaginal discharge -ve

Abdominopelvic Scan

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

CT Scan

MANAGEMENT

Plan

  • Right kidney not visualized

  • Left kidney hypertrophic

  • Uterus didelphus

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

Intra Operative Findings

  • Vulva normal looking with intact hymen

  • Bulge in right vaginal wall noted

  • One normal-looking cervix identified

on the left side

  • Incision made on bulge

  • 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

Final Diagnosis

Post Operative Course

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

Abdominal Examination

  • 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

  • No visceromegaly

Local Examination

General Physical

Examination

  • Vulva

Normal looking

  • Hymen

Intact, no bulge seen

  • Pelvic examination

Not done

INVESTIGATIONS

Past Medical History

Not significant

Past surgical History

H/O appendectomy - 5 months back

Systemic Examination

  • Pulse 92/min
  • BP 100/70 mmHg
  • Temp afebrile
  • Pallor -ve
  • Jaundice –ve
  • Cyanosis –ve
  • Edema –ve
  • Thyroid not enlarged
  • Lymph nodes not palpable

BY

Unremarkable

Personal History

EXAMINATION

  • 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

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