Low complete transverse vaginal septum, vesico-ureteric reflux and low anorectal malformation

Abstract

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).

Previously perforated transverse vaginal septum becomes obstructed: A case report

“…According to the consensus of the European Society of Human Reproduction and Embryology (HSHRE) and European Society of Gynecological Endoscopy (ESGE) [10] , our patient would be classified as U0C0V3, since she had no anomalies of either the uterus or the cervix with a TVS. We used almost all the diagnostic tools reported to be beneficial in this case with our patient, we performed transvaginal and transabdominal U/S which could identify the pathological condition and vaginal structure, we also performed CT scan and MRI both of which are also reported to be used in the diagnosis of the condition, with MRI having the advantage of ability to distinguish between highly situated TVS and congenitally absent cervix by visualization of the cervix [6] . Our initial expectant plan of management has also been advocated by others [11] , however; it was replaced by CS delivery due to non-reassuring CTG.…”

“…Afterwards, we opted for a non-surgical management of the patient's TVS using dilators and Foley's catheter which was also reported to be successful by others [4] , although the dilatation method is advised by some reports for small septa, or as an adjunct to surgery to improve outcomes [6] . Several surgical techniques have been proposed, particularly for cases with low TVS such as transverse incision over the vault of the vagina followed by anastomosis [12] , or Z plasty especially with septa of less than 1 cm thickness, while larger septa (> 1 cm) may be managed by longitudinal Z plasty [6] , or Y plasty [13] , although none of the surgical management techniques has been without complications, the most outstanding among which post-operative stenosis is the most common [6,12] . The rarity and singularity of our case arise from several points, first, the history given by the patient indicates a perforated TVS, yet, we could not identify the perforation both by examination of the lower uterine segment during her CS, and by vaginal examination under anesthesia.…”

“…Most of the publications about TVS seem to agree on an incidence that varies between 1:40,000 and 1:84,000 [1,4,5] . Unlike the etiology which remains a matter of debate, although recently it is believed to be multifactorial [6] . TVSs are broadly classified as perforated or imperforated, based on the presence or absence of communication between the vagina and the uterus [1] , accordingly, clinical symptoms vary.…”

Successful term pregnancy post laparoscopic management of thick perforate upper transverse vaginal septum

“…5 Coital function is usually normal after surgery, and pregnancy rates are 40-50% for septum in the lower or middle third of the vagina. 13…”