A case of Wunderlich syndrome diagnosed by magnetic resonance imaging

Abstract

Wunderlich syndrome is a rare anomaly affecting the Mullerian and Wolff ducts, and consisting of vaginal duplication, uterus didelphy and ipsilateral renal agenesis. The clinical manifestation is progressive menstrual pain with dysmenorrhea. We report the case of an 11-year-old female. After birth, ultrasound examinations revealed right renal agenesis and she was thereafter followed from infancy. Abdominal magnetic resonance (MR) imaging at 11 years of age showed uterus didelphy, an obstructed hemivagina, and right renal agenesis. Although she had experienced no abdominal symptoms after the onset of menstruation, the MR images clearly demonstrated uterus didelphys with hematocolpos due to an obstrucution on one side of the vagina. She underwent surgery in which the vaginal septum was incised and hematocolopos drained. She has experienced no postoperative complications to date, has regular menstruation and remains asymptomatic. Due to the difficulty in diagnosis during infancy, the existence of uterine didelphy and obstructed hemivagina should be taken into consideration in cases of ipsilateral renal agenesis. We suggest MR imaging is necessary to clarify complications in adolescent girls examined for ipsilateral renal agenesis.