Diagnosis and surgical treatment of obstructed hemivagina and ipsilateral renal anomaly in a dog: a case report

Abstract

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA), also called Herlyn-Werner-Wunderlich syndrome, is an extremely rare Müllerian duct anomaly accompanied by Wolffian duct anomalies. A 10-year-old intact female Yorkshire Terrier weighing 3.35 kg was presented with anorexia, depression, vomiting, and abdominal pain. Radiography, ultrasonography, and computed tomography revealed uterine didelphys, obstructed hemivagina, a cystic structure around the right uterus, and right renal agenesis, leading to the diagnosis of OHVIRA syndrome. An ovariohysterectomy and decompression of the obstructed right hemivagina were performed, and the cystic structure near the right uterine horn was removed by en bloc resection, along with the right uterus and ovary. After the surgical intervention, the patient's symptoms including abdominal pain, anorexia, and depression were immediately resolved. The patient was followed up for 1 month postoperatively with ultrasonography at 2-week intervals, which revealed the progression of mild fluid retention in the right hemivagina. However, no additional urogenital findings were identified, and the patient continued to exhibit no overt clinical symptoms. This case report describes the diagnosis and surgical treatment of the first documented case of OHVIRA syndrome in an animal. Unlike in human medicine, where vaginal septectomy is performed to prevent dilatation of the obstructed hemivagina and thereby resolve clinical symptoms, performing ovariohysterectomy combined with fluid aspiration from the obstructed hemivagina showed a favorable postoperative prognosis in the dog.

Keywords: Gartner duct cyst; Herlyn–Werner–Wunderlich syndrome; OHVIRA; dog; unilateral renal agenesis.

Figure 1

Radiograph (A), ultrasonography (B), and coronal CT image (C,D) of the abdomen. Urogenital malformations. (A) A dilated tubular structure was found along the right abdominal wall in the lower abdomen. (B) Markedly expanded right uterine horn filled with hyperechoic fluid. (C) Right-sided renal agenesis. The left kidney is found without compensatory enlargement. (D) CT scan revealed dilated right uterus and obstructed right hemivagina. In addition, a cystic lesion was found around the right uterine horn.

Figure 2

Fluid aspirated from the urinary bladder (left) and cystic structure (right). The fluid aspirated from the cystic structure between the two reddish, fluid-filled structures exhibited a clear but darker yellow color compared to the urine.

Figure 3

Anatomical schema of the findings from the operation in the ventrodorsal view. A cyst (C) located between the uterine horns (U) was resected with the right uterus and ovary (O). Decompression of obstructed hemivagina (HV) was performed via fluid aspiration. The dotted line is the resection line at the surgery.

Figure 4

Histopathology of the right uterine by HE stain. (A) The right uterus exhibited mild endometrial hyperplasia with hemorrhage and mild glandular ectasia, without overt neoplasia or significant inflammation (no overt pyometra). (B) A mass with well-differentiated glandular structures and fibrous tissue around the cervix was identified, which is suggestive of an endocervical cyst or polyp.