Complete imperforate tranverse vaginal septum with septate uterus: A rare anomaly
A 12-year-old girl sought medical treatment because of 1 year history of worsening cyclic, pelvic, and lower abdominal cramping that evolved into constant sharp pain. She experienced thelarche at 11 years of age and had never menstruated till date. Her general physical examination was normal. Her breasts were Tanner stage 3 with no masses. Her external genitalia were normal without any clitorimeglay. On local examination, a 2 cm blind vaginal pouch was seen. A tender, globular, firm, smooth mass was noted on rectal examination. On transrectal ultrasonography, echogenic fluid was evident in the uterus, cervix and vagina []. Magnetic Resonance Imaging (MRI) of pelvis confirmed the presence of small shallow lower vaginal segment connected to dilated cervix and uterus with normal appearing ovaries. Findings of bicornuate uterus with transverse vaginal septum were ascertained. Kidneys and pelvicalyceal system was seen normal. On the basis of clinical examination and radiologic studies, diagnosis of imperforate transverse vaginal septum was made and decision of septum resection under laparoscopic guidance was taken.\nPatient 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 []. Both tubes were grossly dilated and congested revealing gross hematosalpinx []. 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 []. 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 []. 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.