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Perioperative Evaluation in Herlyn-Werner-Wunderlich Syndrome

Schutt, Amy K. MD; Barrett, Megan R. MD; Trotta, Brian M. MD; Stovall, Dale W. MD

doi: 10.1097/AOG.0b013e318265e35a
Case Report

BACKGROUND: Herlyn-Werner-Wunderlich syndrome is defined by uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. We report the presentation, radiographic findings, and outcomes of three patients with Herlyn-Werner-Wunderlich syndrome who underwent surgical management at a tertiary care academic medical center.

CASES: Two patients were diagnosed by magnetic resonance imaging and one by ultrasonography. All three underwent successful transvaginal septoplasty and drainage of the hematocolpos and hematometra. One required septoplasty revision with temporary vaginal stent placement.

CONCLUSION: Herlyn-Werner-Wunderlich syndrome is a rare condition. The most urgent concern is the obstruction of menstrual effluent. Unlike an isolated transverse vaginal septum, the vaginal septum with Herlyn-Werner-Wunderlich syndrome is parallel to the patent vaginal canal, less pliable, and closer to the cervix. These anatomical differences result in pronounced distortion with significant diagnostic and surgical challenges.

Herlyn-Werner-Wunderlich syndrome is a complex Müllerian anomaly necessitating magnetic resonance imaging or two-dimensional ultrasound imaging for diagnosis and surgical planning.

From the Departments of Obstetrics and Gynecology and Radiology and Medical Imaging, University of Virginia, Charlottesville, and the Department of Obstetrics and Gynecology, Riverside Regional Medical Center, Newport News, Virginia.

See related article on page 944.

Corresponding Author: Amy K. Schutt, MD, University of Virginia Health System, Department of Obstetrics and Gynecology, P.O. Box 800712 Charlottesville, VA 22903; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2012 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.