Neovagina creation using sigmoid colon in vaginal agenesis: a case report and review of literature

Mullerian duct anomalies are rare and can present with abnormalities in upper vagina, cervix, uterus, and fallopian tubes. The exact incidence of cervicovaginal agenesis is unknown and there are very few cases recorded in the literature. Authors report a 12-year-old girl referred from gynaecologist with chronic cyclical abdominal pain with underdeveloped, geniatilia and developed secondary sexual characters. Radiological investigations showed hypoplastic cervix with hematometra and left hemato salpinx. A definitive repair with creation of a neovagina using a sigmoid colon segment was performed in a single stage. Many techniques are described for reconstruction of cervicovaginal canal. Use of colon in creation of a neovagina is described by authors. Here we report a case of complete vaginal agenesis presenting with Hematometra-Hematosalpinx where a neovagina was created using a segment of sigmoid colon. Single staged surgery for neovagina creation using segment of sigmoid colon offers a promising and safe alternative for cervicovaginal agenesis.

Unicornuate uterus with functional non communicating rudimentary horn: a refractory cause of dysmenorrhea

Mullerian duct anomalies are rare. Unicornuate uterus with a non-communicating rudimentary horn is a rare type of mullerian duct anomaly which occurs due to defective fusion of malformed duct with contralateral duct. The incidence is approximately 1:100000. Patient usually remain asymptomatic due to the absence of functional endometrium in most of the cases. If the rudimentary uterine horn has an endometrium lined uterine cavity and doesn’t communicate externally then the signs and symptoms of obstructed menstruation appears, as soon as menarche begins. It will be associated with severe dysmennorhoea and hematometra. Other complications may be abdominal lump, chronic pelvic pain, infertility, endometriosis, adenomyosis and ectopic pregnancy in rudimentary horn. Authors are presenting a case of refractory dysmenorrhea with lump abdomen in a patient with unicornuate uterus with functional non communicating horn. In a patient with refractory dysmenorrhea mullerian duct anomaly should be kept as differential diagnosis.

The wandering twin: A case of a uterine didelphys with the obstructed hemiuteri in the anterior abdominal wall

@#Mullerian duct anomalies (MDAs) are congenital defects of the female genital system that arise from abnormal embryological development of the Mullerian ducts. A didelphys uterus, also known as a "double uterus," is one of the least common amongst the MDAs. Reported here is a case of a 16 year old female with a uterus didelphys with the obstructed left hemiuteri adherent in the anterior abdominal wall, and an endometriotic cyst on the same side. She underwent hysteroscopy-guided vaginoscopy, laparoscopic left hemihysterectomy, left oophorocystectomy. Cases such as these require careful preoperative planning and diagnostic imaging for more accurate diagnosis and, hence, for the most appropriate surgical procedure to be carried out. 3D ultrasonography and Magnetic Resonance Imaging have been the most widely used imaging techniques. The goals of management are to relieve the symptoms of obstruction and to restore the normal anatomy as much as possible in order to provide the best chance for future fertility.

Scar endometriosis – A clinical rarity.

Scar endometriosis is a rare occurrence. Endometriosis is presence of endometrium at ectopic sites, other than the uterine cavity. Though the common sites of endometriosis are pelvic structures, extra pelvic endometriosis is occasionally seen. But presence of endometriosis in previous incision scars is extremely rare. Endometriosis in abdominal incision sites following Cesarean scions, hysterectomy, ovarian endometrioma removal are described. Very few cases of endometriosis at episiotomy site are also described in literature. This case report describes two such cases of scar endometriosis. The first case had scar endometriosis following a laparotomy done for rudimentary horn pregnancy. The second case had endometriosis in the scar of previous laparscopic surgeries, performed for ovarian endometrioma.

Revisión pictográfica de las anomalías de los conductos de Müller por resonancia magnética / Pictographic review of Müllerian duct anomalies by magnetic resonance imaging

Las anomalías útero-vaginales o müllerianas son un grupo de patologías congénitas que se originan por un defecto del desarrollo, fusión o canalización de los conductos de Müller en la etapa embrionaria, excepcionalmente pueden deberse a una alteración adquirida. La mayoría se diagnostica en forma tardía, como resultado de estudios de infertilidad o complicaciones obstétricas tempranas o tardías. La resonancia magnética (RM) es un examen no invasivo, que no utiliza radiación ionizante, con una alta resolución de contraste, que permite la evaluación multiplanar de las malformaciones müllerianas, permitiendo su aproximación diagnóstica y caracterización, complementando otras técnicas de imágenes como la histerosalpingografía y la ecografía ginecológica. El radiólogo debe estar familiarizado con las alteraciones anatómicas de los genitales femeninos y su representación en RM permitiendo un diagnóstico diferencial apropiado, oportuno y en consecuencia, un tratamiento adecuado. Este artículo describe los hallazgos en este grupo de malformaciones según la clasificación de la American Fertility Society, la más utilizada en la literatura actual.

The uterus-vaginal or Müllerian anomalies are a group of congenital diseases that are caused by a developmental defect, merger or channeling of Müllerian ducts in the embryonic stage, exceptionally may be due to an acquired disorder. Most belatedly diagnosed as a result of studies of infertility or early or late obstetric complications. Magnetic resonance imaging (MRI) is a noninvasive test that does not use ionizing radiation, with high contrast resolution, which allows multiplanar evaluation of Müllerian malformations, allowing its diagnostic approach and characterization, complementing other imaging techniques such as hysterosalpingography and gynecological ultrasound. The radiologist should be familiar with the anatomical abnormalities of the female genitalia and its representation in MRI, allowing an appropriate and timely differential diagnosis, and consequently, an appropriate treatment.

Hallazgos en resonancia magnética de las malformaciones uterovaginales: datos imprescindibles previos a una intervención quirúrgica / Magnetic resonance imaging findings of uterovaginal malformations: essential data prior to surgical intervention

La caracterización de las malformaciones congénitas del aparato genital femenino ha adquirido gran relevancia, principalmente en mujeres jóvenes con problemas de fertilidad. El origen de estas malformaciones procede de una alteración en el desarrollo embriológico de los conductos de Müller. El manejo terapéutico de estas entidades dependerá tanto del tipo de anomalía como de su gravedad. En la actualidad los múltiples avances tecnológicos en imagen permiten un diagnóstico preciso de estas malformaciones así como una posible planificación quirúrgica. Este trabajo tiene como objetivo revisar la clasificación de las malformaciones müllerianas así como estudiar los hallazgos en resonancia magnética que el cirujano debe conocer previo a la cirugía.

Morphologic characterization of congenital malformations of the female genital tract has acquired great importance, especially in the evaluation of female infertility.The origin of these malformations comes from an alteration in the embryological development of the Müllerian ducts. Technological advances in the field of radiology allow the diagnosis of these malformations, its possible treatment and surgical planning. This paper aims to review the classification of Müllerian anomalies and study the magnetic resonance findings that the surgeon should know prior to possible surgery.

A Case of Successful Unilateral Singleton Pregnancy in Incidentally Detected Uterine Didelphys.

Uterine didelphys or duplication of uterus is a rare congenital anomaly, which constitutes approximately 5% of mullerian duct anomalies. There is failure of the fusion of mullerian ducts resulting in the duplication of uterus and cervix. We report a case of uterine didelphys, which was incidentally detected in a 23 years old G2P1 patient who came for ultrasound with complaints of bleeding per vaginum. MRI was done and uterine didelphys was confirmed. Six months later that patient came again with 6 weeks pregnancy in the right uterine body. We did all antenatal follow up scans in this patient till 36 weeks. Lower segment cesarean section (LSCS) was done at 38 weeks and patient delivered a normal baby of 2.9-kilogram weight.