Staged Treatment of Recurrent Obstructed Hemivagina in Herlyn–Werner–Wunderlich syndrome with Double Vagina: A Case Report and Mini-Review

Background: Herlyn–Werner–Wunderlich syndrome (HWWS) is a rare congenital Müllerian anomaly characterized by uterine didelphys, obstructed hemivagina, and ipsilateral renal malformation, and postoperative recurrence is even more uncommon. This report details a unique case of recurrent obstructed hemivagina in Herlyn-Werner-Wunderlich syndrome with double vagina, managed with a staged surgical approach. Case presentation: We report a 19-year-old woman with a history of two prior vaginal septum resections who presented with recurrent pelvic pain and fever. Imaging revealed uterine didelphys, duplicated cervices and vaginas, complete obstruction of the right hemivagina, and ipsilateral renal agenesis. Vaginoscopy demonstrated a deeply recessed recurrent cavity with purulent fluid, indicating persistent obstruction and local infection. Given the distorted postoperative anatomy, a staged surgical strategy was adopted: initial hysteroscopic decompression and septal incision under ultrasound guidance, followed by definitive reconstruction including resection of the accessory pseudo-vaginal tract, obliteration of the residual obstructed chamber, and vulvar repair. The patient recovered well, achieved regular painless menstruation, and experienced no recurrence during follow-up. Conclusions: This case highlights a complex recurrent variant of HWWS and underscores the essential role of MRI and endoscopic assessment in delineating atypical anatomy. Individualized, stepwise surgical correction is critical for preventing restenosis, controlling infection, restoring normal genital tract continuity, and preserving future reproductive potential in patients with complicated or recurrent HWWS.