Congenital absence of fallopian tube segments

Torsion causing interruption of the ampullary portion of the fallopian tube

OBJECTIVE

To present a description of a young girl who presented acutely with symptoms and findings that are consistent with acute adnexal torsion, where resultant outcome would have led to perception of a congenital anomaly.

DESIGN

Case report.

SETTING

Tertiary pediatric hospital.

PATIENT(S)

A young girl who presented acutely with symptoms consistent with adnexal torsion but who was found to have a torsion affecting a paratubal cyst and the midsegment of her fallopian tube.

INTERVENTION(S)

A salpingectomy was performed because of damage involving the ischemic paratubal cyst and tubal segment that left too little residual tube to allow for a future anastomosis of the residual unaffected components.

MAIN OUTCOME MEASURE(S)

Operative findings, which give an explanation for midsegmental tubal absence.

RESULT(S)

This case challenges previous reports that absent midsegment of a tube is a rare congenital anomaly.

CONCLUSION(S)

Absent midsegment of a tube can be explained as an acquired anomaly, rather than proposing an unusual congenital anomaly.

Congenital partial atresia of the Fallopian tube

Partial tubal atresia is a rare anomaly of unknown pathogenesis. It can occur unilaterally or bilaterally, mainly including the proximal isthmic portion or the proximal ampullary segment ('mid-portion'), and is especially associated with uterine anomalies. Any more extensive pelvic surgery, including preoperative diagnosis of associated urological anomalies, must be well planned in such patients. Salpingostomy and fimbrial approximation is a realistic option in patients with congenital ampullary atresia who wish to have a child. A MEDLINE search was performed and 18 patients found with partial atresia of different tubal portions. This report describes a further patient and reviews the available literature.

Fertility potential of women with congenital ampullary atresia of the fallopian tube

OBJECTIVE

To determine the fertility potential of women with congenital ampullary atresia of the fallopian tube.

DESIGN

Case report and review of literature.

SETTING

University-affiliated tertiary care infertility clinic.

PATIENT(S)

Six infertile women with congenital ampullary atresia of the oviduct.

INTERVENTION(S)

Salpingostomy and fimbrial approximation.

MAIN OUTCOME MEASURE(S)

Pregnancy.

RESULT(S)

Of six reported cases of congenital ampullary atresia of the fallopian tube who underwent surgery, four women conceived intrauterine pregnancies (IUP) and another, a pregnancy of undetermined site.

CONCLUSION(S)

Salpingostomy and fimbrial approximation is a therapeutic option for infertile women with congenital ampullary atresia of the fallopian tube.

Transverse vaginal septum associated with tubal atresia

Transverse vaginal septum is a defect of vertical fusion during embryogenesis of the vagina. The estimated incidence is 1 per 30,000 to 84,000 women. It is infrequently associated with genitourinary tract, gastrointestinal tract, musculoskeletal, and cardiac malformations. Previous reports of transverse vaginal septum have included unilateral absence of the fallopian tube and ovary and absence of the proximal portion of the fallopian tube. This report describes bilateral tubal atresia associated with a transverse vaginal septum. A 17-year-old nulligravida sought medical assessment because of primary amenorrhea and cyclic pelvic pain. Physical examination revealed a blind vaginal pouch and a tender pelvic mass. Radiologic studies showed a transverse vaginal septum 1.5 cm distal to the cervix. The septum was resected with laparoscopic guidance, and bilateral fallopian tubal atresia was noted. The pelvis was otherwise normal. Patients commonly have a pelvic or abdominal mass, pain, and amenorrhea at time of expected menarche. Surgical resection is the treatment of choice. Postoperative dilation may be necessary to prevent restenosis. Outlook for pregnancy is encouraging despite a higher than normal incidence of spontaneous abortion and endometriosis in such patients.