Obstructive mullerian anamolies: a case series

AIM of the study was to review the heterogeneous clinical presentations and management options for some of the obstructive mullerian anomalies through a case series. Background: Müllerian duct anomalies (MDAs) are a miscellaneous group of entities that result from the non-development, defective vertical or lateral fusion, or resorption failure of the müllerian ducts due to genetic mutation. 5 cases of obstructive mullerian anomaly are reviewed. Cases of OHVIRA (obstructed Hemivagina with Renal Agenesis) syndrome, transverse vaginal septum, imperforate hymen and obstructed rudimentary horn of unicornuate uterus are included. Results: We found that cyclical abdominal pain was the most common presenting complaint. There is a high incidence of associated renal anomalies. Psychosocial counselling before treatment is necessary to address the functional and emotional aspects of the patient. Surgical management was done in all patients with good postoperative outcome. Conclusion: Obstructive mullerian anomalies need to be evaluated by a meticulous examination and imaging studies to reach the diagnosis with precision. The treatment has to be tailored to the specific anomaly.

Management of transverse vaginal septum by vaginoscopic resection: hymen conservative technique / Manejo do septo vaginal transverso por ressecção vaginoscópica: técnica conservadora do hímen

Abstract Transverse vaginal septum is a rare female genital tract anomaly, and little is described about its surgical treatment. We report the case of a patient who wished to preserve hymenal integrity due to social and cultural beliefs. We performed a vaginoscopic resection of the septum under laparoscopic view, followed by the introduction of a Foley catheter in the vagina, thus preserving the hymen. After 12 months of follow-up, no septal closure was present, and the menstrual flow was effective. Vaginoscopic hysteroscopy is an effectivemethod of vaginal septum resection, even in cases in which hymenal integrity must be preserved due to social and cultural beliefs.

Resumo Septo vaginal transverso é uma anomalia rara do trato genital feminino, e pouco é descrito sobre o tratamento cirúrgico. Relatamos o caso de uma paciente que desejava preservar a integridade do hímen devido a crenças sociais e culturais. Realizamos ressecção vaginoscópica do septo sob visão laparoscópica, seguida da introdução de um cateter de Foley na vagina, preservando assim o hímen. Após 12 meses de acompanhamento, não havia fechamento do septo, e o fluxo menstrual era eficaz. A histeroscopia vaginoscópica é um método eficaz de ressecção dos septos vaginais, incluindo os casosemque a integridade do hímen deve ser mantida devido a crenças sociais e culturais.

Vaginal Obstruction after Excision of a Transverse Vaginal Septum: A Rare Case Report

A vaginal obstruction often occurs as a result of complication in women who had previously undergone an excision of a transverse vaginal septum. Her we are reporting a case of 12 years old unmarried girl presented with complaint of secondary amenorrhea and cyclic pain lower abdomen since two months. She was operated for cryptomenorrhea four months back. On examination under anaesthesia Thick scarred septum was present in vaginal canal about 6-7 cm from vaginal introitus .After sharp dissection hematocopos bulge seen and drained, residual scar tissue excised , posterior and anterior vaginal wall reconstructed. Vaginal mould inserted to maintain patency

Tabique vaginal transverso diagnosticado en dos hermanas: Reporte de dos casos / Transverse vaginal septum diagnosed in sisters: Cases report

El tabique vaginal transverso es una anomalía que se originaría por un fracaso en la fusión y/o canalización del seno urogenital y de los conductos müllerianos con baja frecuencia, pero con un importante impacto en la salud de las pacientes que lo presentan. El tratamiento es quirúrgico y la vía de abordaje depende de la localización y del espesor del tabique. En ocasiones, se ha relacionado con una herencia que podría ser recesiva asociada al sexo, pero se han documentado pocos casos de asociación familiar. Se exponen los casos de dos hermanas que presentaron esta rara entidad con 5 años de diferencia y que se diagnosticaron por la aparición de dolor abdominal hipogástrico intenso a la edad de 11 y 12 años, cuando presentaban un desarrollo puberal estadio III de Tanner y amenorrea primaria.

Transverse vaginal septum is a disorder that would arise from a failure in the fusion and/or channeling of the urogenital sinus and the müllerian ducts with low frequency but with a significant impact on the health of patients. The treatment is surgical and it will depend on the location and thickness of the septum. Sometimes, it described a female sex-limited autosomal recessive transmission but few cases of family association have been reported. We present the cases of two sisters who had this rare entity 5 years apart and were diagnosed by the presentation of an intense hypogastric abdominal pain at the age of 11 and 12 years when they had a Tanner stage III pubertal development and primary amenorrhea.

A case of transverse vaginal septum with modified Garcia technique / 대한산부인과학회지

The incidence of all transverse vaginal septum is 1:2,100 - 1:72,000. The transverse vaginal septum is a developmental defect of vagina which may be fused incompletely between the Mullerian duct component and the urogenital sinus component of vagina. Serious complications may be hematocolpos, hematometra and hematosalpinx. Simple surgical excision or simple incision have been developed to treat congenital transverse vaginal septa, but also caused common complications such as secondary tissue contracture. Garcia technique using eight vaginal mucosa flaps was developed to avoid common complication of secondary vaginal stenosis. Here, we present a case of contracted transverse vaginal septum who has been performed a simple incision 13 years ago, successfully performed the modified Garcia technique without serious postoperative complication.

Case Report: A new surgical technique for Transverse Vaginal Septum / 대한산부인과학회지

Transverse vaginal septum, especially completely imperforate condition, is a rare congenital anomaly of female genital tract. The patient was 26 years old and visited for primary amenorrhea and low abdominal pain. Secondary sexual characteristics were all normal, but the depth of the vagina was only about 1cm. Hematometra was suspected and two large cystic structures were detected in the pelvis on ultrasonography. Intravenous pyelography and other laboratory results were normal. Vaginoplasty was needed to drain out the hematometra. We tried a new surgical technique using radial incisions of the closed vaginal end. To prevent postoperative contracture, we used a sterile pen case. and educated the patient to dilatate the vagina with that, daily. Here, we report a case of complete imperforate transverse septum with reviews of literatures.

Transverse Vaginal Septum: Difficult Management Concerning Postoperative Stricture: Report of 2 Cases / 대한산부인과학회잡지

Two cases of incomplete transverse vaginal septum with a small opening in the upper third of vagina were presented. One case was a patient presenting at 31 years of age for evaluation of primary infertility and oligomenorrhea. Diagnosis was made by hysterosalpingography, tranvaginal ultrasonography, MRI, and diagnostic pelviscopy for evaluation of abnormality of endopelvic organs. The patient was treated with surgical resection of septum (simple septectomy). Examination 3 months later demonstrated narrowing of the vaginal lumen. Another case was a patient presenting intrauterine pregnancy at 8 weeks and 2 days accompanying transverse vaginal septum with small opening. She had previous septotomy history and presented postoperative scarring. She had septectomy and anastomosis of the mucosa, and presented postoperative narrowing again about a month postoperatively. In this report we describe the two cases of transverse vaginal septum. We also reviewed the literature including diagnostic and treatment guidelines. Prevention of postoperative scarring is the most important factor in management of transverse vaginal septum. For that, first of all, initial septectomy should be done with approximation of the mucosa and postoperative dilatation is necessary. Importance of the initial accurate septectomy is too important to be over-emphasized.

A Case of Transverse Vaginal Septum with Microperforation Which got Pregnant by Intrauterine Insemination / 대한산부인과학회잡지

The mullerian ducts join the sinovaginal bulb at a point known as the mullerian tubercle. Canalization of the mullerian tubercle and sinovaginal bulb is necessary to give a normal vaginal lumen. If the area of junction between these structures is not completely canalized, a transverse vaginal septum will occur. This may be partial or complete and generally lies at the junction of the upper third and lower two thirds of the vagina. It occurs in about 1 per 75,000 females. Partial transverse vaginal septa have been reported in diethylstilbestrol (DES)-exposed females. In the prepubertal state, diagnosis is generally not made unless there is the development of a mucocolpos or mucometrium behind the septum. At puberty, however, if the septum is complete, hematocolpos and hematometrium may occur in a fashion similar to that seen in the imperforate hymen, except that there is no bulging at the introitus. The patient with an incomplete transverse septum may bleed somewhat but will still develop hematocolpos and hematometrium over time and may also complain of foul smelling vaginal discharge.