Background: Many patients are admitted to accident and emergency departments with acute abdominal pain. Herlyn-Werner-Wunderlich syndrome (HWWS) is one of the less well-known causes of this. It is characterised by uterine didelphys with an obstructed hemivagina and ipsilateral renal agenesis or dysplasia.
Case description: A 16-year-old girl presented to the emergency department with progressive abdominal pain and a previous history of renal and anal abnormalities. Acute appendicitis was suspected because of both tenderness on pressure and rebound tenderness, and a raised C-reactive protein level. Abdominal ultrasonography revealed a cystic structure, probably of ovarian or tubal origin. An emergency laparoscopy was performed as ovarian torsion was suspected. This revealed uterine didelphys with an abnormal right horn. Additional abdominal MRI scan diagnostic revealed abnormalities consistent with HWWS.
Conclusion: Congenital urogenital abnormalities should be included in the differential diagnosis of patients with a previous history of renal or anal abnormalities who present with progressive abdominal pain or dysmenorrhoea.