DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20173510

Complex mullarian duct abnormality in a young female: a theraputic dilemma

Mukta Agarwal, Bhawana Tiwary, Prajnanika Gurung

Abstract


Genital outflow tract obstruction is a rare cause of primary amenorrhoea. Cervical agenesis is a very rare condition often associated with atresia of vagina. Clinical diagnosis is usually difficult before surgery. Transverse vaginal septum or vaginal agenesis is also a rare condition that results from incomplete fusion between vaginal components of the mullerian ducts and urogenital sinus. If the septum is complete, the menstrual flow will be obstructed causing primary amenorrhoea. The septum is basically a membrane of fibrous connective tissue with both muscular and vascular components formed anywhere along the vagina during embryological development. Here we present a case of 18 year old female who presented with primary amenorrhea, cyclical lower abdominal pain and menouria since 5 years. There was no history of attainment of menarche. The clinical examination revealed a small, blind ending lower vagina with a tough transverse membrane separating the lower portion from the upper genital tract. The ultrasound examination revealed a normal size uterus with hematometra. The magnetic resonance imaging of pelvis confirmed the presence of hematometra and transverse vaginal septum. Transverse vaginal septum resection followed by abdomino-perineal cervicoplasty was done in this patient.


Keywords


Cervical agenesis, Menarche, Menuria, Primary amenorrhea, Transverse vaginal septum, Urogenital sinus

Full Text:

PDF

References


Junqueira BL, Allen LM, Spitzer RF, Lucco KL, Babyn PS, Doria AS. Mullerian Duct Anomalies and Mimics in Children and Adolescents: Correlative Intraoperative Assessment with Clinical Imaging. Radiographics. 2009;29(4):1085-1103.

Lodi A. Clinical Statistics Clinical Contribution on the Obstetric and Gynecological Obstetric Vaginosis in Milan from 1906 to 1950. Ann Obstet Gine. 1951;73:1246.

Opoku BK, Djokoto R, Owusu-Bempah A, Amo-Antwi K. Huge abdominal mass secondary to a transverse vaginal septum and cervical dysgenesis. Ghana Med J. 2011;45(4):174-6.

Troiano RN, McCarthy SM. Mullerian duct anomalies: imaging and clinical issues. Radiology. 2004;233(1):19-34.

Oppelt P, Renner SP, Brucker S, Strissel PL, Strick R, Oppelt PG et al. The VCUAM (Vagina Cervix Uterus Adnex‚Äďassociated Malformation) Classification: a new classification for genital malformations. Fertili Steril. 2005;84(5):1493-7.

Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Human Reprod. 2013;28(8):2032-44.

Kumar S, Satija B, Wadhwa L. Complex mullerian duct anomaly in a young female with primary amenorrhoea, infertility, and chronic pelvic pain. J Hum Reprod Sci. 2012;5(3):295-7.