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Complete imperforate tranverse vaginal septum with septate uterus: A rare anomaly.

Jain N, Gupta A, Kumar R, Minj A - J Hum Reprod Sci (2013)

Bottom Line: A 12-year-old girl sought medical assessment because of severe cyclic lower abdominal cramping and pelvic pain.Hysteroscopy revealed presence of uterine septum which was resected by a resectoscope.Laparoscopic guided abdominoperineal approach is better in such a case as multiple mullerian anomalies may coexist with each other.

View Article: PubMed Central - PubMed

Affiliation: Vardhman Trauma and Laparoscopy Centre Pvt. Ltd. A-36, South Civil Lines, Mahavir Chowk, Muzaffarnagar - 251 001, Uttar Pradesh, India.

ABSTRACT
The isolated, complete, transverse vaginal septum is one of the most infrequent anomalies of the female genital tract, and when it coexists with a septate uterus, it is even rarer. This report describes a case of transverse vaginal septum with septate uterus. A 12-year-old girl sought medical assessment because of severe cyclic lower abdominal cramping and pelvic pain. Local examination revealed a blind vaginal pouch of 2 cm and on rectal examination a tender pelvic mass was noted. Radiological examination showed transverse vaginal septum in the lower vagina with bicornuate uterus. Surgical resection of the vaginal septum was done under laparoscopic guidance. Hysteroscopy revealed presence of uterine septum which was resected by a resectoscope. Post-operative dilatation of vagina was done to prevent restenosis. Laparoscopic guided abdominoperineal approach is better in such a case as multiple mullerian anomalies may coexist with each other.

No MeSH data available.


Related in: MedlinePlus

Laparoscopic view of internal genitalia suggesting bicornuate uterus with swelling below the isthmus
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Figure 2: Laparoscopic view of internal genitalia suggesting bicornuate uterus with swelling below the isthmus

Mentions: Patient was placed in dorsal lithotomy position. Under general anesthesia (GA), verres needle was introduced and pneumoperitoneum was created. Primary 10 mm intraumbilical trocar was put. One left paraumbilical 5 mm port was created. Uterus was seen as a heart shaped structure with two distinct horns and central depressing groove suggesting a bicornuate uterus [Figure 2]. Both tubes were grossly dilated and congested revealing gross hematosalpinx [Figure 3]. The ovaries were normal in appearance, size, and shape. There was a huge swelling below the uterine isthmus as if the uterus is sitting on a big ball. On local genital examination, blind vaginal pouch of 2 cm was seen. Transverse vaginal septum was identified and grasped with allis tissue holding forceps and stab incision was given. Thick old clotted blood collection of about 700 ml drained out and swelling below the uterus was seen reducing in size and finally disappeared [Figure 4]. The uterine contour altered and now had a broad flat fundus with a central depression suggesting a septate uterus. The vaginal septum was lifted with tissue forceps and separated from vaginal mucosa circumferentially with a scalpel. This approach was used to avoid post-operative stricture formation. Everting sutures were taken at 2, 5, 7, 10 o′ clock position. On hysteroscopy, intrauterine septum was seen and same was resected using resectoscope with monopolar electrode [Figure 5]. Pediatric Foleys no. 8 was inserted and balloon was inflated with 4 ml saline. Post-operative recovery was good and uneventful. Oral estradial valerate 8 mg per day was started to produce uniform endometrial lining. Patient was discharged on the second postoperative day. Weekly follow up was advised to the patient. The patient had vaginal bleeding for about 15 days. Foleys was removed after one month. Regular vaginal dilatation with a vaginal sponge covered with a condom was advised in view of preventing recurrence. Patient comes for regular follow up in every 3 months and is having regular menstrual cycles now.


Complete imperforate tranverse vaginal septum with septate uterus: A rare anomaly.

Jain N, Gupta A, Kumar R, Minj A - J Hum Reprod Sci (2013)

Laparoscopic view of internal genitalia suggesting bicornuate uterus with swelling below the isthmus
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3713583&req=5

Figure 2: Laparoscopic view of internal genitalia suggesting bicornuate uterus with swelling below the isthmus
Mentions: Patient was placed in dorsal lithotomy position. Under general anesthesia (GA), verres needle was introduced and pneumoperitoneum was created. Primary 10 mm intraumbilical trocar was put. One left paraumbilical 5 mm port was created. Uterus was seen as a heart shaped structure with two distinct horns and central depressing groove suggesting a bicornuate uterus [Figure 2]. Both tubes were grossly dilated and congested revealing gross hematosalpinx [Figure 3]. The ovaries were normal in appearance, size, and shape. There was a huge swelling below the uterine isthmus as if the uterus is sitting on a big ball. On local genital examination, blind vaginal pouch of 2 cm was seen. Transverse vaginal septum was identified and grasped with allis tissue holding forceps and stab incision was given. Thick old clotted blood collection of about 700 ml drained out and swelling below the uterus was seen reducing in size and finally disappeared [Figure 4]. The uterine contour altered and now had a broad flat fundus with a central depression suggesting a septate uterus. The vaginal septum was lifted with tissue forceps and separated from vaginal mucosa circumferentially with a scalpel. This approach was used to avoid post-operative stricture formation. Everting sutures were taken at 2, 5, 7, 10 o′ clock position. On hysteroscopy, intrauterine septum was seen and same was resected using resectoscope with monopolar electrode [Figure 5]. Pediatric Foleys no. 8 was inserted and balloon was inflated with 4 ml saline. Post-operative recovery was good and uneventful. Oral estradial valerate 8 mg per day was started to produce uniform endometrial lining. Patient was discharged on the second postoperative day. Weekly follow up was advised to the patient. The patient had vaginal bleeding for about 15 days. Foleys was removed after one month. Regular vaginal dilatation with a vaginal sponge covered with a condom was advised in view of preventing recurrence. Patient comes for regular follow up in every 3 months and is having regular menstrual cycles now.

Bottom Line: A 12-year-old girl sought medical assessment because of severe cyclic lower abdominal cramping and pelvic pain.Hysteroscopy revealed presence of uterine septum which was resected by a resectoscope.Laparoscopic guided abdominoperineal approach is better in such a case as multiple mullerian anomalies may coexist with each other.

View Article: PubMed Central - PubMed

Affiliation: Vardhman Trauma and Laparoscopy Centre Pvt. Ltd. A-36, South Civil Lines, Mahavir Chowk, Muzaffarnagar - 251 001, Uttar Pradesh, India.

ABSTRACT
The isolated, complete, transverse vaginal septum is one of the most infrequent anomalies of the female genital tract, and when it coexists with a septate uterus, it is even rarer. This report describes a case of transverse vaginal septum with septate uterus. A 12-year-old girl sought medical assessment because of severe cyclic lower abdominal cramping and pelvic pain. Local examination revealed a blind vaginal pouch of 2 cm and on rectal examination a tender pelvic mass was noted. Radiological examination showed transverse vaginal septum in the lower vagina with bicornuate uterus. Surgical resection of the vaginal septum was done under laparoscopic guidance. Hysteroscopy revealed presence of uterine septum which was resected by a resectoscope. Post-operative dilatation of vagina was done to prevent restenosis. Laparoscopic guided abdominoperineal approach is better in such a case as multiple mullerian anomalies may coexist with each other.

No MeSH data available.


Related in: MedlinePlus