Vaginal agenesis: A case report / Philippine Journal of Obstetrics and Gynecology

Congenital anomalities of the vagina are rare congenital anomalies. Women born with this anomaly present with collection of blood in the uterine cavity or hematometra and pelvic pain. Presented is a case of a 12-year old girl with hypogastric pain and primary amenorrhea complicated by vaginal agenesis. She was managed conservatively by creating a neovagina with the use of bipudental flap or Modified Singapore flap. Management can be non-surgical or surgical but the management of congenital vaginal agenesis remains controversial. The decision to do a conservative surgical procedure or a hysterectomy depends on the clinical profile of the patient, the expertise of the surgeons, the extent of the anomaly, and it's association to other congenital anomalies.

The pitfalls in the diagnosis and management of distal vaginal agenesis: a report of three cases

Vaginal agenesis is an uncommon congenital anomaly and such complex malformations are usually incorrectly identified. Deviations from the normal embryologic events in the reproductive system may result to malformations which may exhibit with the same clinical presentation. A complete history and physical examination coupled with appropriate imaging techniques are necessary to arrive at a correct diagnosis. Physicians must be aware of the differential diagnosis and management options available. A correct diagnosis must be made prior to any surgical intervention to prevent inappropriate surgeries with their anticipated complications. In cases with vaginal outlet obstruction, an accurate diagnosis with the adequate treatment reduces the need for re-operations and subsequent complications. Reported are three misdiagnosed cases of distal vaginal agenesis resulting to unwarranted surgical interventions.

A single-blind randomized trial of manual pulmonary inflation in the postoperative pain management after gynecologic laparoscopy

Background: Abdominal pain following laparoscopic gynecological surgery is a common complaint of patients requiring longer hospital stay and additional consumption of analgesics. Residual intra-abdominal gas plays a critical role in the etiology of post-laparoscopy abdominal pain. Certain methods have been done to reduce the incidence of abdominal pain. However, these methods require additional devices and drugs which not only increase the cost but also the risks of side effects. Objective: The objective of this study was to determine the efficacy of a clinical maneuver which involve placing the patient in the Trendelenburg position and manual pulmonary inflation as a method of removal of residual carbon dioxide to reduce postoperative pain after gynecologic laparoscopic surgery. Methodology: This is a single-blind randomized trial of 39 patients scheduled for elective laparoscopic gynecological surgery. Patients were randomly assigned into two groups of removal of residual intra-abdominal gas. In the control group, residual gas was removed by passive exsufflation through the cannula while in the intervention group, patients were placed in Trendelenburg position, passive deflation and manual pulmonary inflation done consisting of five positive pressure ventilations. Postoperative abdominal pain scores were measured at the 4, 12, 24, 36 and 48 hours after surgery and during follow-up using a Visual Analog Scale (VAS). Results: A total of 39 patients (19 in the control group and 20 in the intervention group) were included in the study. The postoperative abdominal pain scores in the control group and intervention group were 4.58 - 1.39 compared with 2.60 - 2.07 at the 12th , 3.68 - 0.95 compared with 2.00-0.65 at the 24th, 2.53-1.07 compared with 1.40-0.88 at the 36th and 2.00-0.58 compared 1.15 - 0.93 at the 48th hour following surgery and during the first week after surgery (1.52-0.84 compared with 0.40-0.75) with P level -.05. The control group had a greater incidence of nausea,bloated feeling and shoulder tip pain at the 12th and 24th hour surgery. The control group also required additional doses of analgesics within the 48 hours after surgery and during the follow-up period. Conclusion: Manual pulmonary inflation is a simple and cost effective maneuver that significantly reduces laparoscopy-induced abdominal pain and other symptoms such as nausea, vomiting, bloated feeling and shoulder tip pain in laparoscopic gynaecological patients. This maneuver is also associated with less usage of analgesics.