A Rare Case of Vaginal Atresia in an Adolescent Girl Presenting With Abdominal Pain

Vaginal atresia, an infrequent congenital anomaly characterized by the absence or underdevelopment of the vaginal canal, presents significant complexities in pediatric and adolescent gynecological practice. Its diverse range of clinical presentations, including primary amenorrhea and cyclic abdominal discomfort, creates diagnostic challenges, highlighting the need for timely intervention to relieve symptoms and preserve future reproductive health. This case underscores the essential role of a collaborative, multidisciplinary approach involving pediatricians, gynecologists, and surgeons in ensuring comprehensive care and optimizing patient outcomes. In this report, we present the case of a 10-year-old female who initially presented with chronic abdominal pain, which had been occurring intermittently over the course of several months. This ultimately led to the diagnosis of hematometra secondary to vaginal atresia. Utilizing magnetic resonance imaging, we confirmed the diagnosis without exposing the patient to radiation, prioritizing her safety. A successful surgery was performed to create a working vaginal canal. The patient received careful postoperative care, and we closely followed her progress to support a smooth recovery.

A Catastrophic Outcome of Ineffectual Episiotomy Causing Acquired Vaginal Atresia: A Case Report

Episiotomy is an aid done to prevent perineal tears, which may involve the anal sphincter and rectum. However, if not given judiciously, this can result in an increase in morbidity in patients. We present a case report of two young females who presented to our outpatient department with a complaint of vaginismus after their previous vaginal deliveries. The first patient had partial vaginal atresia and the second patient had complete vaginal atresia after an episiotomy repair. The complication arose due to mismanaged episiotomy repair that had a severe impact on their physical, sexual, and psychological well-being. They both underwent vaginal stricture release and adhesiolysis showed satisfactory outcomes during their follow-up. Though not recommended, prophylactic episiotomy continues to be widely performed. The approach adopted during the operative delivery stays unclear, as episiotomy execution is likely to be impacted by the physician's working environment, as well as maternal and fetal circumstances. Trained execution at rural or urban and private or public facilities is the need of the hour. Counseling regarding prophylactic or emergency episiotomy and its consequences during labor should be considered as a part of their antenatal care.

Endoluminal Silicone-Covered Stenting in Children: Novel Applications and Lessons Learned

BACKGROUND

Silicone-covered endoluminal stents have been applied to various hollow visceral disorders in adult patients with varying success. Efficacy of retrievable endoluminal stenting in children is less well-established.

PURPOSE

The purpose of this study was to evaluate our experience with evolving applications of endoluminal silicone-covered stenting in children.

RESEARCH DESIGN

Eight children 19 years and younger having silicone-covered stent placement for various indications at a single institution (2014-2021) were reviewed retrospectively.

RESULTS

Eight patients received a total of 26 silicone-covered stents. Four stent placements (15.4%) were associated with a direct adverse event. To resolve the endoluminal disorder, four patients received multiple stents or further intervention. When evaluating novel applications, clinical benefit was noted for one patient with vaginal atresia, and another after ileal pouch anal anastomosis disruption.

CONCLUSION

This experience highlights the broad and innovative applications for endoluminal silicone-covered natural orifice stenting in children. Acute processes respond well and rapidly to stenting, although chronic, established fistula may require additional manipulations or surgery.

Vaginal atresia and cervical agenesis combined with asymmetric septate uterus: A case report of a new genital malformation and literature review

RATIONALE

A combination of Vaginal atresia and septate uterus as a novel genital malformation has been reported the first time. It offers a support for the bidirectional theory.

PATIENT CONCERNS

A 23-year-old woman presented with the inability to perform intercourse. The unprecedented variant was misdiagnosed by magnetic resonance imaging and ultrasonography as low vaginal atresia associated with complete septate uterus with functional endometrium in both the cavities.

DIAGNOSES

The correct diagnosis was made and confirmed intraoperatively as a genital malformation, vaginal atresia and cervical agenesis associated with septate uterus.

INTERVENTION

laparoscopic and hysteroscopic diagnosis the novel malformation never been reported and a vaginal stent was recommended postoperatively.

OUTCOMES

This rare clinical variant made misdiagnosis. Intraoperatively, unprecedented genital malformation was confirmed. There are no vaginal atresia cases in the literature with a septate functional uterus and single agenesis cervix.

LESSONS

Confirmed diagnosed by operation instead of depending on the imaging should be used for rare genital anomaly.

Robotic approach to vaginal atresia repair in an adolescent girl

A 9-year-old girl presented to us, after failed perineal approach for vaginal atresia, with abdominal pain. She was thoroughly evaluated and contrast enhanced computed tomographic was done, which revealed absence of lower 1/3^rd of vagina with normal uterus, fallopian tubes and ovaries. There was no associated anomaly. She was successfully managed by a combined robotic and perineal approach. Follow-up after 6 and 12 months revealed large capacious vagina with healthy mucocutaneous junction.

Creation of a neovagina by the Vecchietti procedure in a patient with corrected high imperforate anus

BACKGROUND

Vaginal atresia is often associated with high imperforate anus. Because the commonly used methods of surgical vaginal creation (eg, McIndoe, intestinal segment interposition) may adversely affect urinary and fecal continence, the less-invasive Vecchietti procedure was selected for a young adult with a successfully corrected high imperforate anus.

METHODS

A 21-year-old was born with a high imperforate anus, vaginal atresia, right hemi-uterus, and left renal agenesis. A colostomy was done at birth, a pull-through procedure at 9 months, and a stoma closure 3 months later. At age 13, an obstructed and dilated right hemiuterus and fallopian tube were resected. A laparoscopic version of the Vecchietti procedure was used for creation of a neovagina.

RESULTS

After the patient had been in the hospital for 2 days, traction was gradually advanced every other day in the office. At 2 weeks postoperatively, the bead was removed revealing a 7-cm vagina. Further elongation was achieved using the Frank method, while continence remained intact.

CONCLUSION

The Vecchietti procedure is an attractive, minimally invasive alternative for creation of a neovagina in patients at risk for compromise to their vesico-anorectal continence.