Management of Transverse Vaginal Septum by Vaginoscopic Resection: Hymen Conservative Technique

Abstract

Transverse vaginal septum is a rare female genital tract anomaly, and little is described about its surgical treatment. We report the case of a patient who wished to preserve hymenal integrity due to social and cultural beliefs. We performed a vaginoscopic resection of the septum under laparoscopic view, followed by the introduction of a Foley catheter in the vagina, thus preserving the hymen. After 12 months of follow-up, no septal closure was present, and the menstrual flow was effective. Vaginoscopic hysteroscopy is an effective method of vaginal septum resection, even in cases in which hymenal integrity must be preserved due to social and cultural beliefs.

Transverse vaginal septum managed by simple flap surgery technique: A case report

“…There are several surgical options, like vaginal approach, combined abdominoperineal approach and also laparoscopic resection from abdominal approach [ 3 , [6] , [7] , [8] ]. There are few guidelines in the medical literature regarding the classification of transverse vaginal septum or various surgical procedures in TVS.…”

Previously perforated transverse vaginal septum becomes obstructed: A case report

“…The etiology of TVS remains a debatable issue, between the theories of failure of fusion of the Mullerian system which forms the upper vaginal part and the sinovaginal bulb which forms the lower part, the theory of failure of canalization of the vaginal plate, or a combination of both [1,4] . The first theory fusion failure is support by histopathological examination of TVSs, in which the cranial side is lined by columnar epithelium of Mullerian origin, whereas, the caudal side is lined by squamous epithelium of the urogenital sinus.…”

“…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] .…”

“…Transverse vaginal septum (TVS) is one of the rare congenital anomalies of the development of the Mullerian duct [1] , it was first reported in 1872 by Delaunay [2] , then reappeared in literature again 72 years later in a report by Dannreuther [3] . 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] .…”

“…On the contrary, perforated TVS may be asymptomatic and an incidental finding upon vaginal examination due to complains such as dysmenorrhea, dyspareunia, or infertility [7] . Regardless of perforation, there is a consensus on the frequency of TVS with regards to position in the vagina, with 46% located in the upper, 35% in the middle, and 19% in the lower vagina [4,5] based on the findings of the largest available to date case series of female genitourinary congenital anomalies [8] . Here we present a rare case report of a female with presumably perforated TVS based on history that later on became obstructed during the course of management.…”