Uterus Didelphys with Obstructed Hemivagina, Hematocolpos, and Hematometra
Shakila Yasmin, Sidrah Batool
Keywords: Uterus didelphys, obstructed hemivagina, hematocolpus, hematometra, pelvic pain
ABSTRACT
Uterus didelphys presenting with the obstructed hemi-vagina, hematocolpos, and hematometra is an infrequent entity and is usually diagnosed late as patients often have normal menstrual cycles. If it is associated with ipsilateral renal agenesis, the condition is called Herlyn-Werner-Wunderlich syndrome (HWW). Patients with this condition present with progressive pelvic pain after menarche, urinary retention, and palpable mass. It is usually due to the presence of hematocolpos and hematometra. Condition is diagnosed on the basis of genitourinary symptoms, local examination, and radiological findings.
INTRODUCTION
The uterus is derived from two paramesonephric ducts that extend caudally and fuse in the midline to form the uterus and cervix while the upper portion remains patent and develops into fallopian tubes. The upper one-fourth of the vagina is developed from the Mullerian duct while the lower fifth is developed from the urogenital sinus1. Uterus didelphys is a symmetrical anomaly that occurs due to the failure of fusion of mesonephric ducts. Malformations of the female genital tract occur due to disturbance of embryological development of Mullerian ducts caused by various environmental, genetic, and teratogenic factors.
CASE PRESENTATION
A 20-year-old lady, married for six months R/O Ahmadpur admitted to Gynae Unit II, BahawalVictoria Hospital, Bahawalpur through OPD on 28- 5-2023 with the complaint of painful menstruation for the last 5 years. The pain started one day before the onset of menses, moderate in intensity and dull in character, associated with nausea and vomiting, relieved by menstruation and taking analgesics, aggravated by performing household activities, but no urinary and bowel symptoms. Her menstrual cycle was regular with the average flow, and she used to bleed for 4 days after every 28 days and used to soak 1-2 homemade sanitary pads that were mildly soaked there was no history of intermenstrual or postcoital bleeding or dyspareunia. She menarched at the age of 15 years, the couple never practiced any method of contraception, and a pap smear was never taken. She is nulliparous.
DISCUSSION
There should be a clear diagnostic and therapeutic strategy for patients presenting with c/ o dysmenorrhea and menstrual irregularities in whom we suspect congenital malformation of the genital tract so that unnecessary surgical intervention should be avoided. A basic pelvic USG should be done, but MRI is more accurate to completely diagnose such a condition,5 and laparoscopy might be helpful when imaging is not clear.
CONCLUSION
The congenital urogenital anomalies in females are very diverse. Some mullerian anomalies are easily diagnosed but others have very unusual presentations that make diagnosis and management difficult.
Keywords: Uterus didelphys, obstructed hemivagina, hematocolpus, hematometra, pelvic pain