Successful Management of Complete Transverse Vaginal Septum

A 22-year-old woman married for 1year with severe persistent right iliac fossa pain presented to the gynecology OP in our hospital. she disclosed history of primary amenorrhoea and cyclical lower abdominal pain on and off. On physical examination, her height was 160 cm, breast development was normal for her age, and other secondary sexual characteristics were normal for her age, on examination -per abdomen-soft, no palpable mass.On pelvic examination- external genitalia normal, speculum examination revealed a blind-ending vagina 6cm from the introitus and Could not visualize cervical external os . She had no known medical problems, and no family history of genetic abnormalities.

Trans vaginal ultrasonography revealed 77x63mm blood filled cyst present in posterior vaginal wall. These findings were consistent with hematocolpos .MRI revealed large cystic lesion in vaginal cavity with mild hemorrhage, the cyst appears to communicate with the endocervical canal- ? Hematocolpos. Based on history, findings and scan reports diagnosed as transverse vaginal septum confirmed.

Posterior vaginal wall after draining pus

Posterior vaginal wall after draining pus

Examination under anesthesia revealed bling ending vagina with no bulge and location of septum is high and thick so proceeded with laparoscopic approach .Procedure-Uv fold opened, bladder pushed down, evidence of vaginal bulge noted, anterior colpotomy done, frank pus drained. Pus sent for HPE and TB-PCR.Transverse vaginal septum identified and excision done laparoscopically with guidance from vaginal assistant. Completeexcision ofseptumdone, anterior and posteriorfornix reconstruction done ,followed by cervical dilatation.Aftercervical dilatation hysteroscopy done-no abnormality detected. A mould was prepared and kept in vagina.On second post operative day mould was removed and patient explained the procedure of vaginal dilatation withdilators after applying oestrogen cream and discharged in stable condition. On follow up visit after 1week, no vaginalstenosiswith goodvaginalmucosa notedandafter2months she hadnormalmenstrual cycles.

Contributors

Dr. B Radhika

Senior Gynecologist & Obstetrician, Laparoscopic Surgeon, Infertility Specialist