Herlyn-Werner-Wunderlich Syndrome Complicated with Pyocolpos: An Unusual Cause of Postabortal Sepsis

Abstract

Obstructive mullerian anomalies give rise to a spectrum of clinical presentations and are uncommon in routine gynecologic practice. The patient usually becomes symptomatic in early reproductive years. Recurrent pelvic pain, dysmenorrhea, enlarging abdominopelvic mass, and abnormal vaginal discharge are the common presenting symptoms. We describe a rare case of a mullerian anomaly getting diagnosed 13 years after attaining menarche during the evaluation of postabortal sepsis. Patient presented 2 weeks following evacuation carried out for missed abortion, with acute abdominal pain, fever and foul smelling discharge per vaginum. The anomaly was identified as uterus didelphys with obstructed left hemivagina and ipsilateral renal agenesis (Herlyn-Werner-Wunderlich syndrome) complicated by pyocolpos. She was successfully managed by single-stage transvaginal septum resection under laparoscopic control.

Keywords: Diagnostic laparoscopy; Herlyn-Werner-Wunderlich syndrome; pyocolpos.

Figure 1a

MRI pelvis (axial image) – Uterus didelphys, normal endometrial cavity, normal ovaries, with large collection in left hemivagina

Figure 1b

Open arrow showing communication of collection with left uterine body

Figure 1c

Coronal image – Collection compressing the normal patent vagina on right side (open arrow)

Figure 2a

Laparoscopic view – Both uterine bodies with adnexa are normal. No pelvic collection or purulent exudate through the tubes

Figure 2b

Posterior view of the collection

Figure 3

Anatomical limits of collection identified in relation to the bladder