Successful correction of the transverse vaginal septum with a pinhole vaginal foramen using Y-V plasty: A case report

The transverse vaginal septum, a rare Müllerian duct anomaly, presents diagnostic and therapeutic challenges owing to its variable location, thickness, and potential association with uterine malformations. Therefore, an accurate diagnosis and selection of an appropriate treatment are important. Herein, the case of a 28-year-old nonpregnant woman with sexual dysfunction attributable to a transverse vaginal septum is presented. The septum, approximately 5 mm thick, was situated low on the vaginal wall near the urethral opening, with a small central aperture. Employing Y-V plasty, full extension of the posterior and lateral vaginal walls was achieved while minimizing the manipulation of the anterior wall to avoid urethral injury. Postoperatively, the patient achieved sexual function without vaginal stenosis. Y-V plasty is a minimally invasive and effective approach for preventing postoperative stenosis in the treatment of a thin transverse vaginal septum located low on the vaginal wall.

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.

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

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

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

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

A Scoping Review of the Literature

STUDY OBJECTIVE

Transverse vaginal septae (TVS) are congenital, obstructive anomalies of the vagina typically presenting with abdominal pain and amenorrhea. Currently, the literature about surgical management is sparse. Postoperative complications are common. Vaginal dilation either pre- or postoperatively is sometimes recommended, the outcomes of which are poorly described. The aim of this scoping review was to guide surgical planning, namely, timing and postoperative care, to improve surgical outcomes.

DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME MEASURES

This scoping review followed the Joanna Briggs Institute framework. The population of interest was patients 21 years of age or younger with a TVS. MEDLINE, OVID and CINAHL databases were searched using the subject headings listed herein. Literature written in English and French were included. Excluded were reports on patients with concurrent urogenital anomalies or severe developmental disabilities. The resultant articles were reviewed by 2 independent researchers. A third researcher was used in cases of disagreement. Using a descriptive analytical method, data were extracted from the included articles.

RESULTS

We screened 1441 articles for eligibility; 41 articles met criteria, which described 152 cases of TVS. The most common management was simple vaginal excision. Five studies included outcomes from preoperative dilation, and 11 from postoperative dilation. There were 21 cases of postoperative vaginal stenosis; half (11/21) occurred without postoperative dilation.

CONCLUSION

The goal of this review was to describe how TVS are managed and provide guidance for management options. Although the literature was sparse, the authors believe that management in a tertiary center, and surgical delay until the patient is ready to participate in vaginal dilation will improve outcomes for patients with TVS. Further prospective studies are needed to guide surgical planning.

Transverse vaginal septum managed by simple flap surgery technique: A case report

Background

Transverse Vaginal Septum (TVS) is a rare congenital abnormality, classified as the Mullerian duct anomaly development.^1,2 TVS incidence range from 1:2.000 to 1:72.000. Management of TVS may only requirement local excision with a simple end to end anastomosis of the vagina, and use of skin grafts, but this technique has been reported has common complications of secondary tissue contracture, which often lead to stenosis of the vagina.³ In this case we managed TVS with simple flap technique to avoid such postoperative complications and maintain caliber of vagina.

Case

A 11 years old girl complained cyclical abdominal pain since a year ago without history of menstrual blood. Patient already had vaginal surgery for removing menstrual blood, but after vaginal surgery the menstrual blood cannot be removed, then referred to our hospital. Ultrasound examination revealed hematometra and hemocolpos. The septum location was 3,38 cm proximal distance from vaginal introitus with the thickness of 8.1 mm. We performed simple excision of the septum with formerly performed distal vaginal septum mucosa preparation creating lateral flaps, then approximating the flaps to the edge of the proximal vaginal mucosa with interrupted suture continued with hymenorraphy. The patient has no complaint 6 months after surgery with vaginal length 8 cm, and had regular menstrual cycle.

Conclusion

A simple flap surgery technique can be done in transverse vaginal septum, with no complication such as tissue contracture, vaginal stenosis, or insightly scarring. This is a simple technique and can be done with hymenorraphy to restore normal anatomy of hymen.

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Transverse vaginal septal is a rare case.

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Simple flap technique is simple procedure with excellent outcome.

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Simple flap technique is usefull to prevent post-operative complication due to patient compliance problem.

Congenital anomalies causing hemato/hydrocolpos: imaging findings, treatments, and outcomes

Hemato/hydrocolpos due to congenital urogenital anomalies are rare conditions discovered in neonatal, infant, and adolescent girls. Diagnosis is often missed or delayed owing to its rare incidence and nonspecific symptoms. If early correct diagnosis and treatment cannot be performed, late complications such as tubal adhesion, pelvic endometriosis, and infertility may develop. Congenital urogenital anomalies causing hemato/hydrocolpos are mainly of four types: imperforate hymen, distal vaginal agenesis, transverse vaginal septum, and obstructed hemivagina and ipsilateral renal anomaly, and clinicians should have adequate knowledge about these anomalies. This article aimed to review the diagnosis and treatment of these urogenital anomalies by describing embryology, clinical presentation, imaging findings, surgical management, and postoperative outcomes.

Management of a transverse vaginal septum complicated with hematocolpos in an adolescent girl: Case report

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Hematocolpos remains the main consequence of the transversal septums of vagina.

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The management of transversal septum of vagina is essentially based on surgery.

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The risk of vaginal stenosis after surgery remains high.

Introduction

The transverse septum of the vagina or vaginal septum is a rare abnormality of the female genital tract. The most frequently advanced etiology is a defect in the fusion and/or channelling of the urogenital sinus and Mullerian conductors. This structural obstruction can completely obstruct the vagina and thus can cause a haematocolpos associated with cyclic pelvic pain shortly after menarche in adolescent girls. The diagnosis of a vaginal septum is based on a careful clinical gynaecological examination and especially on ultrasound scan via the abdominal or transrectal (see Transperineal) and in more complex cases on MRI. The treatment is surgical and must be carried out as early as possible.

Case report

We report the management of a case of a 16 year old girl who presented a haematocolpos complicating a complete transverse vaginal septum. The treatment consisted of making a transverse incision in the centre of the transverse septum of the vagina, draining the hematocolpos and visualising the cervix. A circumferential excision of the septum was made and the remaining vaginal edges were then sutured by a simple tarring of the entire circumference with Vicryl 2.0. A sponge soaked in oestrogen cream was placed in her vagina to prevent stenosis and removed the day after the operation. The patient was followed in our department for 2 years without any recurrence of vaginal stenosis or hematocolpos.

Conclusion

The transverse vaginal septum remains a rare anomaly of the female genital tract, the reasons for its discovery are extremely variable according to its shape and location. Haematocolpos remains the main consequence of these septums. The management is essentially based on surgery while taking into account the risks of postoperative stenosis and the repercussions on the upper genital tract.

Transverse Vaginal Septum with a Hemiuterus: A Laparoscopic-Guided Abdominoperineal Approach

BACKGROUND

Transverse vaginal septum is a rare Müllerian anomaly that can coexist with other defects.

CASE

A 12-year-old patient was referred to our clinic for cyclic, lower abdominal pain. Magnetic resonance imaging revealed the presence of a transverse vaginal septum, a hemiuterus with a nonfunctioning rudimentary horn, and left unilateral ureter and kidney. The septum was excised laparoscopically assisted by a vaginal dilator to guide the dissection. The mucosal gap of the vagina was then bridged with sutures using the perineal approach. The postoperative course was uneventful and the patient was discharged with instructions for vaginal dilations.

SUMMARY AND CONCLUSION

Early identification of a transverse vaginal septum and careful planning of the operation can improve the outcome of corrective surgery and prevent possible complications.

Vaginal reconstruction for distal vaginal atresia without anorectal malformation: is the approach different?

INTRODUCTION

Distal vaginal atresia is a rare condition and treatment approaches are varied, usually driven by symptoms.

METHODS

A retrospective review was performed to identify patients with distal vaginal atresia without anorectal malformation. Data collected included age and symptoms at presentation, type and number of operations, and associated anomalies.

RESULTS

Eight patients were identified. Four presented at birth with a hydrocolpos and four presented with hematometrocolpos after 12 years of age. Number of operations per patient ranged from one to seven with an average of three. The vaginal reconstruction was achieved by perineal vaginal mobilization in four patients and abdomino-perineal approach in four patients. One patient, with a proximal vagina approximately 7 cm from the perineum, required partial vaginal replacement with colon. In addition, she had hematometrocolpos with an acute inflammation at the time of reconstruction despite menstrual suppression and drainage which may have contributed to the difficulty in mobilizing the vagina. In five patients, distal vaginal atresia was an isolated anomaly. In the other three cases, associated anomalies included: mild hydronephrosis that improved after hydrocolpos decompression (2), cardiac anomaly (2), and vertebral anomaly (1).

CONCLUSION

In this series, a distended upper vagina/uterus was a common presentation and the time of reconstruction was driven by the presence of symptoms. Drainage of the hydrocolpos/hydrometrocolpos with menstrual suppression in post-pubertal patients, followed by further work-up, and planned reconstruction is a good surgical strategy.

Asymptomatic microperforated transverse vaginal septum presenting with primary infertility: a rare form of mullerian anomaly

Transverse vaginal septum is a rare type of mullerian anomaly resulting from failure of the canalization of the vaginal plate at the point where the urogenital sinus meets the mullerian duct and usually presents at menarche with symptoms of outflow tract obstruction. Instead, patients with a perforated septum often have normal menses and usually present with difficulties with intercourse or infertility. A 24-year-old patient with 5 years of infertility is reported. Following assessment, isolated microperforated transverse vaginal septum (U0C0V3 according to the new classification system of the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy for congenital uterine anomalies) was detected with no additional urogenital anomaly and simple excision of the septum and end-to-end vaginal anastomosis was performed. The patient became pregnant spontaneously 2 months after the operation when sexual intercourse was permitted. Transverse vaginal septum, which presented itself with no clinical findings and only primary infertility, is discussed with a review of the existing literature.

Intralesional Steroid Injections for Recurrent Vaginal Strictures

BACKGROUND

Postoperative complications after transverse vaginal septum excision include stricture formation. The purpose of this report is to describe use of intralesional corticosteroid injections for vaginal strictures.

CASE

A 32-year-old gravida 0 with history of transverse vaginal septum and recurrent strictures presented for follow-up of chronic pelvic pain. After her fourth septum revision, the patient underwent a total of 7 triamcinolone injections at the septum tissue. The course of triamcinolone injections improved the stricture and patient's pain.

SUMMARY AND CONCLUSION

Steroid injection into the vaginal septum tissue can be a safe and effective adjuvant therapy after septum resection. Although it is an established adjuvant therapy in other specialties, further studies are warranted to show a decrease in the recurrence rate of vaginal strictures.

A CASE REPORT OF PREMENARCHIAL TRANSVERSE VAGINAL SEPTUM AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN

Premenarchial Transverse vaginal septum is a benign condition. The septum may be found in the upper, middle or lower vagina. A case report of a premenarchial girl with transverse vaginal septum managed at the university college hospital, Ibadan, in January 2009. Diagnosis was made following a history of primary amenorrhea, cyclical low abdominal pain and pelvic examination which revealed a vaginal septum. She had surgical resection of the vaginal septum and a vaginal stent was left in-situ to keep the vagina patent during the healing process. The procedure was uneventful and she was able to achieve menstrual flow following surgery. Follow up visits were essentially unremarkable.

Low complete transverse vaginal septum, vesico-ureteric reflux and low anorectal malformation: Case report and review of literature

The complete, imperforate transverse vaginal septum is one of the rare anomalies of the female reproductive tract. This anomaly is a disorder of vertical fusion of the Müllerian ducts and can present with or without obstruction. It has been classified as Type IIA as per the American Fertility Society (AFS) classification. Its thickness and site varies in the vaginal canal; the upper and middle third septa are common. The diagnosis can be made in newborns, infants, and adolescent girls. It is found associated with urological anomalies, anorectal malformation (ARM), and bicornuate uterus. We present a case of a 13-year-old girl with hematometrocolpos due to an imperforate complete low vaginal septum, left-sided vesico-ureteric reflux (VUR), and ectopic anus (low ARM).

Treatment of Virgin OHVIRA Syndrome with Haematometrocolpos by Complete Incision of Vaginal Septum without Hymenotomy

Mullerian malformations result from defective fusion of the Mullerian ducts during development of the female reproductive system and have an incidence of 2-3%. The American Fertility Society classification of Mullerian anomalies is the most commonly utilized standardized classification. The least common form of these malformations is Herlyn-Werner-Wunderlich syndrome characterized by obstructed hemivagina and ipsilateral renal anomaly (OHVIRA). This syndrome has been described with case reports since 1922. Early diagnosis and surgery that include drainage of fluid and resection of the vaginal septum is necessary for OHVIRA to prevent late complications (i.e. pyocolpos, chronic cryptomenorrhea). Here in we report a case of Herlyn-Werner-Wunderlich syndrome that hymen has been preserved during the operation of non-fenestrated transverse vaginal septum resection with hysteroscopy.

Double Cross Plasty for Management of Transverse Vaginal Septum: A 20-Year Retrospective Review of Our Experience

OBJECTIVES

Evaluation of double cross plasty for management of obstructive or non obstructive transverse vaginal septum.

METHODS

13 patients presented either as cryptomenorrhoea or as infertility/dyspareunia were diagnosed to have transverse vaginal septum. They were subjected to double cross plasty and were subsequently followed up for period of two years.

RESULTS

13 patients presented either as cryptomenorrhoea or infertility/dyspareunia. Nine patients had transverse vaginal septum at low level, three at midlevel, and one had high-level septum. The thickness of septum was 1-3 cms in 12 patients. Double cross plasty was performed in all patients. One patient with high vaginal septum which was thick needed bilateral labial flaps. All patients were followed up to period of 2 years and none had restenosis. Three patients had pregnancies with vaginal delivery in two of them.

CONCLUSION

Double cross plasty for management of transverse vaginal septum is a better technique compared with currently used surgical methods. In our series, it did not cause restenosis and some of our patients were able to deliver vaginally.