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

Vaginal stenosis treatment using computed tomography and fluoroscopy guidance

INTRODUCTION

Vaginal stenosis is a common complication following construction of a neovagina with vascularized myocutaneous flaps. This is primarily because of inconsistent or inappropriate vaginal dilator use. Image-guided recanalization, especially for obstructed genitourinary tracts, is an emerging idea in interventional radiology. Although multiple surgical techniques have been reported to treat vaginal agenesis or obstruction, the idea of image-guided recanalization of vaginal stenosis is a relatively new management strategy for vaginal stenosis.

CASE

We present a challenging case of a patient who initially presented with the complaint of increasing pelvic pressure after the creation of a neovagina via vaginoplasty. She had a distal neovagina created after extensive surgical resection for a large infiltrating pelvic rectal adenocarcinoma. A computed tomography scan revealed a fluid-filled neovaginal abscess. Examination under anesthesia revealed complete stenosis of the neovagina with no identifiable tract for dilation.

INTERVENTION

A computed tomography scan and fluoroscopy-guided sharp recanalization of the stenosed neovagina was performed, followed by serial fluoroscopic balloon angioplasty to dilate the stenosed neovagina. Finally, the patient underwent a gynecologic surgery for the excision of remaining granulation tissue to produce a more permanent patent neovagina, followed by regular and proper use of vaginal dilators to ensure patency.

CONCLUSION

This case report demonstrates that image-guided techniques can be used to aid in vaginal recanalization in the postoperative setting.

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.

Robotic management of congenital urethra-vaginal fistula with transverse vaginal septum

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