Case Report: Soft endoscopic treatment of Herlyn-Werner-Wunderlich syndrome: an innovative clinical procedure for hymen preservation.

BACKGROUND: Herlyn-Werner-Wunderlich syndrome (HWWS) management typically requires hymenotomy. We describe the fully endoscopic, hymen-sparing septotomy in a patient with no history of sexual intercourse. CASE PRESENTATION: A 20-year-old patient with no prior sexual intercourse and progressive dysmenorrhea was diagnosed by MRI with HWWS, presenting as uterus didelphys, obstructed right hemivagina, and left renal agenesis. A 9-mm flexible gastroscope and endoscopic submucosal dissection (ESD) knives were introduced through the intact hymen to resect an 11 × 13 mm oblique septum, evacuating 20 mL of chocolate fluid. The hymen remained intact. The patient was discharged on postoperative day 3 and remained asymptomatic at 2-month follow-up, with no residual hematocolpos detected on ultrasound. Telephone follow-up at 12 and 18 months postoperatively confirmed no recurrence of dysmenorrhea. CONCLUSION: Endoscopic septotomy safely relieves HWWS obstruction while preserving hymenal integrity in patients with no sexual history. This novel technique addresses a crucial patient-centered need and expands therapeutic options for complex Müllerian anomalies.