J Korean Med Sci.  2007 Aug;22(4):766-769. 10.3346/jkms.2007.22.4.766.

Hysteroscopic Resection of the Vaginal Septum in Uterus Didelphys with Obstructed Hemivagina: A Case Report

• Kim TE
• Lee GH
• Choi YM
• Jee BC
• Ku SY
• Suh CS
• Kim SH
• Kim JG
• Moon SY

• KMID: 1127104
• DOI: http://doi.org/10.3346/jkms.2007.22.4.766

Abstract

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis is a rare congenital anomaly. Excision of the obstructed vaginal septum is the treatment of choice for symptom relief and the preservation of reproductive capability. A 14-yr-old girl complained of persistent vaginal spotting following each menstruation. Pelvic magnetic resonance imaging revealed a uterus didelphys with left hematocolpos and ipsilateral renal agenesis. Instead of conventional transvaginal excision of the vaginal septum, we used hysteroscopic excision under transabdominal ultrasonographic guidance to preserve the integrity of the hymen. The postoperative course was uneventful, and clinical symptoms were completely resolved after this intervention. Resectoscopic excision of the vaginal septum was found to be easy, safe, effective, and appropriate for young women as it preserved hymen integrity. We believe that this is the first Korean report on the use of a hysteroscopy for vaginal septum resection in a patient with uterus didelphys with obstructed hemivagina.

Keyword

Mullerian Anomalies; Hematocolpos; Hysteroscopy

MeSH Terms

Adolescent
Female
Humans
Hysteroscopy/*methods
Kidney/abnormalities
Urogenital Abnormalities/surgery
Uterus/*abnormalities
Vagina/*abnormalities/*surgery/ultrasonography

Figure

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  Fig. 1 A T2-weighted coronal MR image demonstrates two uterine horns with a dilated left hemivagina with hematocolpos.

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  Fig. 2 A transabdominal ultrasound image acquired during the operation. The tip of the minihysteroscope (M) in the left obstructed hemivagina (V1) after puncturing the vaginal septum. B, bladder; S, obstructed vaginal septum; U, left uterus; V2, fluid filling the right vagina.

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  Fig. 3 The integrity of hymen preserved after the hysteroscopic resection of the vaginal septum (A: pre-operation, B: post-operation).

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  Fig. 4 The vaginal septum was excised with the resectoscope.

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