Successful Uterovaginal Anastomosis in an Unusual Presentation of Congenital Absence of Cervix

Abstract

Cervical agenesis or dysgenesis (fragmentation, fibrous cord and obstruction) is an extremely rare congenital anomaly. Conservative surgical approach to these patients involves uterovaginal anastomosis, cervical canalization and cervical reconstruction. In failed conservative surgery, total hysterectomy is the treatment of choice. We report what we believe to be the first successful end-to-end uterovaginal anastomosis of an unusual case of congenital cervical agenesis. A 25-yearold female presented complaining of primary amenorrhea and primary subfertility for the same duration. At laparoscopy, complete separation between the cervix and the body of the uterus was found and hanging from surrounding supports. Both ovaries and fallopian tubes were anatomically positioned. There was another muscular tissue of 2 cm in diameter at the pouch of Douglas which was attached with lateral pelvic wall by transverse cervical ligament. Upon readmission, laparotomy was performed under general anesthesia in a semilithotomy position allowing both abdominal and vaginal approaches. Uterovaginal anastomosis was done by the restoration of the genital tract by direct suturing of the isthmus uteri to the vagina. Insertion of a 16F Foley catheter transvaginally through the vaginal opening into the endometrial cavity and was inflated with 5 ml of fluid into the catheter balloon. There were no postoperative complications. Foley catheter was kept in situ for 21 days. Patient had her first menstruation on 11th day of surgery and that was continued for 5 days with regular flow. Consecutive 3-cycles follow-up has been done and the patient is having her normal menstruation. In the presence of cervical anomaly with functional uterus and intact vagina, uterovaginal anastomosis is feasible and effective and should be applied as a first-line treatment option. How to cite this article Mahmud N, Mahtab NT, Chowdhury TA, Deb AK. Successful Uterovaginal Anastomosis in an Unusual Presentation of Congenital Absence of Cervix. J South Asian Feder Menopause Soc 2014;2(2):105-110.