Sonographic‐guided drainage of unilateral hematometrocolpos due to uterus didelphys and obstructed hemivagina associated with ipsilateral renal agenesis

Abstract

The rare specific association of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis has been increasingly recognized in recent years, although diagnosis of this syndrome is still often delayed.Clearly, early recognition of this condition allows for improved management and optimal patient outcome. Sonography has become the preferred diagnostic modality for delineating the precise nature of the abnormal anatomical relationships observed with this synd r~m e .~ We present a case in which sonography provided precise preoperative diagnosis, and also was utilized intraoperatively t o assist conservative surgical management of an affected patient. CASEREPORTA 12-year-old girl presented t o the emergency department complaining of severe recurrent left lower abdominal pain. Her past medical history was unremarkable. She had menstruated regularly during the previous year, with secondary dysmenorrhea of increasing intensity during the 4 months prior to presentation. Physical examination revealed a healthy adolescent in no acute distress with appropriate secondary sexual characteristics. The abdomen was soft with significant tenderness overlying a left lower-quadrant mass. The introitus appeared normal. Rectal examination disclosed a tender pelvic mass.

The Obstructed Hemivagina, Ipsilateral Renal Anomaly, and Uterine Didelphys Triad and the Subsequent Manifestation of Cervical Aplasia

“…Other clinicians have undertaken vaginal septum division under hysteroscopic guidance or sonographic guidance to improve diagnosis and aid management. 20,21 The role of laparoscopy especially as a primary procedure is still controversial and, while it may not be required purely for vaginal septum division, it can aid in diagnosis and management of endometriosis or other pelvic pathology and was ultimately required in our cases for hemi-hysterectomy as definitive treatment. 5,6 …”

Transvaginal sonography of postabortal (redo) syndrome

“…The differential diagnosis of hematometra includes congenital and acquired etiologies. Congenital etiologies include obstruction of the genital tract, imperforate hymen, transverse vaginal septa, cervical atresia, and unilateral obstruction of lateral fusion defects of the genital tract 2–4. Acquired lesions include iatrogenic trauma to the uterine cervix such as cone biopsies, Loop Electric Excision Procedure (LEEP), dilatation and curettage, cervical or endometrial carcinoma, and radiation therapy 5–9…”

Transvaginal ultrasonographic depiction of a Gartner duct cyst.

“…The differential diagnosis of cystic structures located in the upper vagina and uterine cervix includes nabothian cysts, Gartner duct cysts, and, rarely, specific obstructed müllerian duct anomalies (usually uterus didelphys with obstructed hemivagina). [11][12][13] The latter are not true cystic lesions and usually contain echogenic contents (obstructed menstrual debris), and patients with these lesions commonly have cyclic symptoms (primary dysmenorrhea). In contrast, patients with nabothian cysts or Gartner duct cysts are usually asymptomatic.…”

“…In contrast, patients with nabothian cysts or Gartner duct cysts are usually asymptomatic. 11 Ultrasonographic depiction of cystic structures within the uterine cervix are not uncommon, and these usually are considered to represent nabothian (retention) cysts, reported to range between 6 and 20 mm in diameter and located eccentric to the cervical canal. 12,13 Gartner duct cysts also may be depicted in close vicinity to the uterine cervix and also should appear eccentric to the cervical canal.…”