Uterine Didelphys with Transverse Vaginal Septum – A Complex rare Müllerian anomaly

Bicornis unicollis uterus as a risk factor of preterm birth: A case of young woman with multiple premature births

Bicornis unicollis uterus is a rare congenital uterine abnormality that occurs due to the failure of Mullerian duct fusion early in the development of the female internal genitalia system. In this case report, we present a woman with bicornis unicollis uterus who had preterm birth. A 30-year-old female patient with two caesarean sections history with premature babies was presented to the hospital with a complaint of regular contractions for twelve hours in her third preterm pregnancy. The patient has no particular symptoms besides acute abdominal pain. The ultrasonography examination indicated a uterus didelphys with breech presentation fetus. Due to the patient's caesarean history and the fetal presentation, an emergency caesarean section was decided and performed. It was found that the gravid uterus was on the left and the baby was subsequently delivered with a complete placenta. Postoperative condition of the patient was shown to be stable while the baby underwent an intensive care at the neonatal intensive care unit. This case report highlights that early diagnosis in this rare case is critical since bicornis unicollis uterus are mostly asymptomatic. Caesarean section was chosen in the present case based on consideration of the fetal and maternal clinical conditions.

Management of an isolated complete imperforate transverse vaginal septum: A case report

Introduction and importance

The isolated complete transverse vaginal septum (TVS) is a rare congenital abnormality. Which can completely obstructed the vagina, can cause a hematometrocolpos associated with cyclic severe pelvic pain and primary amenorrhea. Management of this case was discussed.

Case presentation

A 14-year-old adelocant girl with primary amenorrhea and severe persistent pelvic pain presented to the gynecology outpatient clinic in our hospital. On pelvic examination, there did not see cervical external os. Radiologic imaging revealed a markedly both fluid intrauterine cavity and upper vaginal canal. The patient underwent general anesthesia, a partial incision of the septum was performed. At discharged time sponge soaked with estrogen cream and 22 number catheter were placed in her vagina to prevent stenosis.

Clinical discussion

Transverse vaginal septum is no symptoms until the age of menarche, and can cause recurrent pelvic pain and amenorrhea. The patient underwent general anesthesia, underwent the partial incision of the septum. Then with end-to-end suturing of the remained vaginal edges, and put urinary 22 number catheter inside the upper vagina for preventing stenosis of the vagina in an operating room.

Conclusion

The excision of septum have put catheter for 3 months with estradiol cream to prevent stenosis and failure of the operation. The management can be performed in the transverse vaginal septum, without any complications. This report gave an option in a simple and effective method that allows the gynecologist to treat this case to reach a good result and still needed to follow up in the future.

•

Haematometrocolpos due to a transverse vaginal septum or imperforate hymen can be a cause of abdominal pain and distension in a young woman.

•

A high index of suspicion is needed to diagnose transverse vaginal septum as the cause of the abdominal pain and late onset of menarche.

•

Radiologic imagings are useful during diagnosis and help with locating and measuring the septum for further surgical correction.

•

The excision of septum have put catheter for 3 months with estradiol cream to prevent stenosis and failure of the operation.