UTERUS DIDELPHYS IN NULLIPAROUS AND MULTIPAROUS WOMEN – A RARE ENTITY

Uterus didelphys is a rare congenital uterine abnormality in which the embryogenetic fusion of the Mullerian ducts fails to occur. It will lead to the formation of a double uterus with two separate cervices and most often a double vagina with a longitudinal septum as well. Here, we present two different cases of uterus didelphys with varied presentations. The first case is a nulliparous woman presented with post-coital bleeding. On examination, two cervical openings with a longitudinal complete vaginal septum were found, conservative management was done. Findings of didelphys uterus were confirmed on USG. The patient was counseled and discharged. The second case is a multiparous woman with previous cesarean delivery, rupture of membranes, and meconium in this pregnancy with term pregnancy taken up for emergency cesarean section. Dense adhesions and a mass on the right side of uterus were found intraoperatively, which on further inspection confirmed to be patent right horn of uterus. Diagnosis of uterus didelphys was made after doing per speculum and per vaginal examination post-cesarean.

Herlyn-Werner-Wunderlich Syndrome: A Rare Congenital Uterine Anomaly

Introduction: Herlyn-Werner-Wunderlich Syndrome is a rare anomaly and exact incidence is not known. It is usually diagnosed in young girls who present with cyclical abdominal pain along with cyclical menstruation. Case Report: We present case of two girls who had this syndrome. An ultrasound was performed in both patients. In first patient, it revealed uterus didelphys with hematocolpos on right side. In the second patient, a large hematometra of size 9.8×12.2 cm, along with hematocolpos was present on the left side. Both the patients underwent examination under anaesthesia and excision of septum. They remained asymptomatic during one year follow-up. Conclusion: Treatment of such cases is excision of septum and to maintain the patency of the outflow tract and prevent stricture formation later. A good follow-up in immediate post-operative period is necessary.

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

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.

Possibilities of Early Ultrasound Diagnostics of the Herlin — Werner — Wunderlich syndrome (Case Report)

Herlin — Werner — Wunderlich syndrome or OHVIRA (Obstructed hemivagina and ipsilateral renal anomaly) is a rare type of uterine and vaginal doubling defect (0,1 – 10,0 % of all uterine abnormalities) which is characterized by a triad of symptoms: uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal dysgenesis. The manifestation of the disease usually present after menarche, is accompanied by severe pain syndrome, leads to redoubted complications and organ-carrying operations with decreasing the fertility. At an earlier age, it can manifest itself as an infection of the genitourinary system. The diagnosis is based on clinical and anamnestic data using instrumental methods, the most accessible and safe of which is ultrasound. This article presents three clinical cases of patients 5 – 6 years old with a description of the ultrasound picture of the OHVIRA syndrome.

Plicae Palmatae on MR in Uterus Didelphys: the Incidence and Morphological Characteristics

Objective: To investigate the incidence of plicae palmatae in uterus didelphys and its morphological characteristics on MR imaging. Methods: We retrospectively collected 37 consecutive female pelvic MR images diagnosed with uterus didelphys between August 2012 and November 2020. Patients with the following conditions were excluded: (a) repeated examination; (b) poor image quality; (c) cervical disease. Axial and coronal T2-weight images and axial three-dimensional (3D) volumetric isotropic T2-weighted acquisition (VISTA) were used to evaluate the ridge of plicae palmatae (RPP). A multiplanar reformation of the cervical axis from 3D-VISTA sequence was performed to measure the height and width of RPP. Non-normal variables based on the Kruskal-Wallis H test was used for statistical analysis. A two-tailed test where P < 0.05 was considered statistically significant. Results: Twenty-six cases were finally included in the statistics. The average age was 25.7±9.0 years (range, 10-45 years). RPP was observed on both cervices in 16 patients (61.5%), only on the left cervix in 3 patients (11.5%), and only on the right cervix in 4 patients (15.4%). There were 3 cases with no RPP observed in any of their cervix (11.5%).All RPP appear symmetrically on the anterior and posterior walls of the cervix. There was no statistically significant difference in height, width, and height/width of the RPP in the left and right cervix (p＞0.05). Conclusions: RPP is encountered in 88.5% patients with duplicated uterine cervices in our cohort. This incidence is similar to that reported in women with normal uterus of reproductive age.

Didelphys Uterus in Pregnancy, an Uncommon Mullerian Duct Anomaly: A Case Report

Introduction: Didelphys uterus, or “double uterus,” is one of the rarest Müllerian duct anomalies (MDA). Due to its rarity, data are sparse on overall outcomes associated with this congenital defect, but it may be associated with several complications, both pregnancy and non-pregnancy related. Case Report: In this case, a pregnant 35-year-old female with vaginal bleeding was subsequently diagnosed with uterus didelphys by transvaginal ultrasound imaging. Conclusion: Despite its rarity, clinicians should be aware of MDAs and their associated complications with pregnancy.