Management of Recurrent Stricture Formation after Transverse Vaginal Septum Excision

Complete transverse vaginal septum complicated by pyocolpos, primary vesicoureteral reflux and ectopic ureter with renal loss: a case report

A transverse vaginal septum is a rare Müllerian anomaly caused by incomplete fusion between the Müllerian ducts and the urogenital sinus. It can obstruct menstrual flow, leading to hematocolpos, hydrocolpos, or pyocolpos. We report a 12-year-old girl with recurrent hematocolpos, abdominal pain, urinary symptoms, and infections. Imaging showed a complete transverse vaginal septum and grade II vesicoureteral reflux. She underwent surgical drainage, septum resection, and ureteral reimplantation. Recovery was favorable, with symptom resolution and preserved renal function. This case emphasizes the need for early diagnosis and a multidisciplinary approach to avoid long-term complications in complex urogenital anomalies.

Management of recurrent adhesion after vaginal recanalization surgery by using interdigitating Y-flap technique: Case series

Introduction

Adhesion is one of complication after vaginal recanalization surgery that occurs due to the free tissue attached during the wound healing process and should be treated carefully. Otherwise, it will become obstruction to the vagina and lead to hematocolpos. The chosen techniques should prevent recurrent adhesion, synechia or stenosis. In this case series, we performed interdigitating Y-flap technique for managing recurrent synechiae post recanalization vaginal surgeries to prevent future stenosis.

Presentation of case

The first case was a 16 years old teenager, complained not menstruating and abdominal pain. Patient already had recanalization vagina surgery for correcting distal vaginal agenesis two years ago. After that, patient already had menstruation. There were hematometra, hematocolpos and vaginal adhesion from examination. The second case was a 12 years old teenager, complained having slight blood menstruation after septum excision surgery. From the examination, there was stenosis vagina at 3 cm proximal from hymenal ring. Both patients were treated by interdigitating Y-flap surgery for correcting the synechiae. After follow up treatment, there was no complaint from patients.

Discussion

Both patients were having synechia post vaginal recanalization surgery. To prevent recurrent synechiae, we decided to do interdigitating Y-Flap technique for correcting synechiae. With this technique, the scar tissue may not develop contractured scar and narrowing vagina.

Conclusion

Interdigitating Y-Flap technique may become an option for managing complex recurrent adhesion, synechia or stenosis. This technique is simple, easier and reduces the risk of stenosis in the future with better scar formations.

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Recurrent Adhesion or synechiae is the common complication of post vaginal recanalization surgeries.

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Interdigitating Y Flap technique as an option for managing recurrent adhesion after vaginal recanalization Surgery

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Interdigitating Y Flap technique in this case is simple, easier and decreases the risk of synechiae post-surgery.

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.

Successful pregnancy following acquired gynatresia

Acquired gynatresia is a common gynecological condition in developing countries where puerperal complications and unskilled interventions prevail. A 23-year-old primipara who had spontaneous vaginal delivery complicated by gynatresia had vaginoplasty that failed due to erectile dysfunction in the spouse. She subsequently developed secondary amenorrhea and was relieved with dilatation and evacuation. She was planned for definitive surgery, however,she incidentally conceived with q pin-hole vagina. She was delivered of a live fetus at term via an elective cesarean section. This case is peculiar as spontaneous conception occurred with a pinhole opening. There is a need to adequately evaluate cases before definitive management to maximize success.

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).

Postpartum Vaginal Stenosis Due to Chemical Vaginitis

Acquired vaginal stenosis is a rare obstructing anomaly, which can be caused by use of chemicals in the vagina. A 21-year-old gravida 1 para 1, presented with secondary amenorrhea and inability to have sexual intercourse, after normal spontaneous vaginal delivery complicated by post partum bleeding. The delivery was conducted by untrained traditional birth attendant at home. The wash cloth soaked with caustic soda was packed in the patient's vagina and was left in situ for 10 days, which ultimately led to the severe scarring and stenosis of the vagina. Patient underwent surgical management and the extensive vaginal adhesions were excised and a patent vagina was reconstructed. Patient then reported successful vaginal intercourse without dyspareunia. Post partum vaginal stenosis due to chemical vaginitis is rare. These cases can be prevented by adequate training of untrained health care workers.