経腟的内視鏡下にOHVIRA（Obstructed hemivagina and ipsilateral renal anomaly）症候群と診断し治療し得た1例

抄録

Prolusion: The syndrome of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) was initially reported in 1922. An accurate diagnosis can typically be made on the basis of patient history and examination, and appropriate imaging, in combination with pathological diagnosis of the vaginal (or perivaginal) cystic wall. A definitive treatment is vaginoplasty to relieve the obstruction. In our case, a minimally invasive transvaginal endoscopic procedure helped in the diagnosis as well as treatment of this condition.

Case report: A 22-year-old virgin girl with a chief complaint of lower abdominal pain was referred to our hospital. Pelvic examination, ultrasound, computed tomography, and magnetic resonance imaging revealed uterus didelphys, left ovarian cyst, and right renal agenesis, and raised a suspicion of an obstructed right vagina. Diagnostic flexible transvaginal endoscopy indicated a flat hemivaginal septum with a pinhole and left uterine cervix, but no right cervix. A preoperative diagnosis of OHVIRA syndrome and left ovarian cyst was made. Laparoscopic left ovarian cystectomy was initially performed. Then, the vaginal septum bulged by injection of saline through the ureteral stent (5Fr) introduced using an angle-type guide wire was fenestrated through a transvaginal endoscopic incision. The patient reported no symptoms at her follow-up visit 28 months after the surgery.

Conclusion: Transvaginal endoscopy is a minimally invasive technique that facilitates the definite diagnosis, and enables safe and precise treatment of OHVIRA syndrome.