{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:10:50Z","timestamp":1788448250505,"version":"build-2803163510"},"reference-count":11,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,1,25]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>Herlyn-Werner-Wunderlich syndrome (HWWS), defined by the triad of uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis, is a rare Mullerian duct malformation, usually diagnosed after menarche, when symptoms related to haematocolpos arise. We report a case of a 14-year-old patient who presented to the emergency department complaining of proctalgia and pelvic pain treated in our medical centre. Ultrasound and abdomino-pelvic MRI imaging studies confirmed the diagnosis. Treatment was surgical incision of the vaginal septum. At the follow-up visit, after the initial procedure, excess vaginal tissue was excised using a hysteroscopic approach during diagnostic vaginoscopy. Vaginoscopy-assisted treatment of the patient proved to be a safe and effective minimally invasive treatment modality that resulted in symptomatic relief and fertility preservation. In conclusion, although premenarche is asymptomatic in the vast majority of cases, HWWS would be optimally diagnosed in childhood to avoid acute late complications, although it is usually first diagnosed after menarche as a result of haematocolpos. Gynaecologists should consider the syndrome in the presence of pelvic mass, renal agenesis, menstrual changes and cyclic pelvic pain.<\/jats:p>","DOI":"10.1136\/bcr-2020-239160","type":"journal-article","created":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T13:31:22Z","timestamp":1614951082000},"page":"e239160","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Herlyn-Werner-Wunderlich syndrome: clinical considerations and management"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2141-4029","authenticated-orcid":false,"given":"Wagner","family":"Horst","sequence":"first","affiliation":[{"name":"School of Medicine, Faculdade Estacio de Jaragu\u00e1 do Sul, Jaragu\u00e1 do Sul, Santa Catarina, Brazil"},{"name":"Health and Environment Postgraduation Program, UNIVILLE, Joinville, Santa Catarina, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael Cardoso","family":"de Melo","sequence":"additional","affiliation":[{"name":"Radiology, Hospital Divina Provid\u00eancia, Porto Alegre, Rio Grande do Sul, Brazil"},{"name":"Radiology, Complexo Hospitalar Santa Casa de Miseric\u00f3rdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Theilacker","sequence":"additional","affiliation":[{"name":"School of Medicine, Faculdade Estacio de Jaragu\u00e1 do Sul, Jaragu\u00e1 do Sul, Santa Catarina, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betina","family":"Schmitt","sequence":"additional","affiliation":[{"name":"School of Medicine, PUCPR, Curitiba, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"2025082723564673000_14.3.e239160.1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jmig.2020.04.013","article-title":"In-office hysteroscopic treatment of Herlyn-Werner-Wunderlich syndrome: a case series","volume":"27","author":"Fascilla","year":"2020","journal-title":"J Minim Invasive Gynecol"},{"key":"2025082723564673000_14.3.e239160.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2014.05.025"},{"key":"2025082723564673000_14.3.e239160.3","doi-asserted-by":"crossref","unstructured":"Mittal R . Herlyn-Werner-Wunderlich syndrome. J Obstet Gynecol India 2016.","DOI":"10.1007\/s13224-015-0707-8"},{"key":"2025082723564673000_14.3.e239160.4","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.ijscr.2019.08.035","article-title":"Aleixes Sampaio Rocha JL, Atuati Maltoni a, das Chagas lima rl, Arias Zendim V, Agulham MA, et al. Herlyn-Werner-Wunderlich syndrome: diagnosis and treatment of an atypical case and review of literature","volume":"63","author":"Girardi Fachin","year":"2019","journal-title":"Int J Surg Case Rep"},{"key":"2025082723564673000_14.3.e239160.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-015-0421-0"},{"key":"2025082723564673000_14.3.e239160.6","doi-asserted-by":"publisher","DOI":"10.1136\/bcr.04.2011.4147"},{"key":"2025082723564673000_14.3.e239160.7","doi-asserted-by":"crossref","first-page":"417","DOI":"10.4103\/0971-3026.190411","article-title":"Embryogenesis of vagina and embryopathogenesis of Herlyn-Werner-Wunderlich syndrome","volume":"26","author":"Aswani","year":"2016","journal-title":"Indian J Radiol Imaging"},{"key":"2025082723564673000_14.3.e239160.8","first-page":"136-40","article-title":"Herlyn Werner wunderlich syndrome with hematocolpos: an unusual case report of full diagnostic approach and treatment","volume":"10","author":"Bhoil","year":"2016","journal-title":"Int J Fertil Steril"},{"key":"2025082723564673000_14.3.e239160.9","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1097\/AOG.0b013e318265e35a","article-title":"Perioperative evaluation in Herlyn-Werner-Wunderlich syndrome","volume":"120","author":"Schutt","year":"2012","journal-title":"Obstet Gynecol"},{"key":"2025082723564673000_14.3.e239160.10","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2342-12-4"},{"key":"2025082723564673000_14.3.e239160.11","first-page":"1253","article-title":"The Herlyn-Werner-Wunderlich triad (OHVIRA syndrome) with good pregnancy outcome - two cases and literature review","volume":"59","author":"Albulescu","year":"2018","journal-title":"Rom J Morphol Embryol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-239160","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:56:56Z","timestamp":1756364216000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-239160"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":11,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,4]]},"published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1136\/bcr-2020-239160"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-239160","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3]]}}}