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Case Reports
. 2022 Oct 19;9(3):e2022.00044.
doi: 10.4293/CRSLS.2022.00044. eCollection 2022 Jul-Sep.

Recurrent Paravaginal Abscess: An Unusual Presentation of a Distal Ectopic Ureteral Remnant

Daniel Y Lovell  1 , Amanda L Merriman  2 , Kristi C Benjamin  2 , Gerald B Taylor  2
Affiliations
Case Reports

Recurrent Paravaginal Abscess: An Unusual Presentation of a Distal Ectopic Ureteral Remnant

Daniel Y Lovell et al. CRSLS. .

Abstract

Introduction: Obstructed hemivagina ipsilateral renal agenesis (OHVIRA) is a rare syndrome with limited data on both treatment and postoperative sequelae, specifically of ectopic ureters to the vagina.

Case description: This case study describes a 22-year-old patient with OHVIRA syndrome presenting with pelvic pain and drainage from a chronic vaginal abscess secondary to a remnant distal ectopic ureter after nephrectomy and proximal ureterectomy. Imaging was significant for a right paravaginal abscess. Previously, the patient was treated with conservative therapy and on presentation her evaluation confirmed a right paravaginal abscess. She subsequently underwent a robot-assisted incision and drainage of the paravaginal abscess and excision of the remnant distal ectopic ureter. She did well postoperatively without recurrence.

Discussion: We discuss the successful surgical technique used to identify and excise a paravaginal abscess. We also highlight the unique anatomy of a patient with OHVIRA syndrome. Lastly, we underline the importance of a complete resection of an ectopic ureter to the vagina at the time of nephrectomy, given the potential risk of ascending chronic infection and recurrent abscess formation.

Keywords: Ascending infection; OHVIRA syndrome; Ureteral stump.

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Conflict of interest statement

Conflict of interests: none.

Figures

Figure 1.
Figure 1.
(A) Pre-operative anatomy, (B) Post-operative anatomy. Left kidney (LK), Right dysplastic kidney (RK), Right ectopic ureter (REU), Right uterine horn (RU), Left uterine horn (LU), Right hemivagina (RV), Left hemivagina (LV), Vagina (V).
Figure 2.
Figure 2.
Pre-operative magnetic resonance imaging: (A) Sagittal, (B) Coronal. Vagina (V), Right uterus (RU), Left uterus (LU), Rectum (R), Bladder (B), Right paravaginal abscess (A).
Figure 3.
Figure 3.
Intraoperative view of pelvis. Right uterus (RU), Left uterus (LU), Colon (C), Bladder (B), Right paravaginal abscess (A).
See this image and copyright information in PMC

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