Ultrasonographic diagnosis and assisted surgical management of hematotrachelos and hematometra due to uterine cervical atresia with associated vaginal agenesis.

Abstract

Congenital atresia of the cervix is a very unusual anomaly of the paramesonephric ducts. In more than 50% of 35 cases reported, additional anomalies of the internal genitalia were noted; 1 the most usual coexisting anomaly noted is vaginal agenesis. 1 The following report il· lustrates the important role of ultrasound in diagnosis and assisted surgical management of these cases. CASE REPORTA 12-year-old premenarchal female presented complaining of recurrent lower abdominal pain. Her first symptoms appeared one month prior to her current admission and persisted for a five-day period. Her past medical history was unremarkable. Physical examination revealed a healthy ado· lescent with apparent early secondary sexual features. A midline lower abdominal mas was palpated suprapubically. The external genitalia were normal. An apparently imperforate hymen was neither distended or discolored. Rectal examination disclosed a moderately tender midline 14 em mass, palpated high in the pelvis. A bidigital exam between the introitus area and the rectum ruled out hematocolpos. Laboratory tests were normal. Ultrasound examination (Dia• sonics DRF 200, 3.5-MHz sector transducer) demonstrated a mass measuring 13 X 6 X5 em. The longitudinal scan revealed an hourglass structure (Fig. 1); the specific anatomy of the inferior aspect of which was depicted separately (Fig. 2). The transverse scan revealed a distended uterus with normal ovaries (Fig. 3); a lower transverse scan revealed the distended cervix (Fig. 4). An intravenous pyelogram demonstrated two normal kidneys and evidence of a mass lying against the bladder. The above findings were compatible with hematotra· chelos and hematometra. Due to the above diagnosis and per· sisting pelvic pain, further examination and therapeutic measures were undertaken. On examination under general anesthesia, no evidence of an existing vagina was found. With continuous ultrasound guidance, a 16-gauge needle was introduced transperineally between the urethra and the rectum. The lower aspect of the above mass was probed and aspiration of dark blood confirmed the diagnosis of an obstructed upper genital tract. At this stage, a large Stamey catheter was inserted along the same tract and 300 ml of dark old menstrual blood removed with negative pressure. Simultaneous ultrasound scanning demonstrated concomitant contraction of the uterine and cervical walls. The catheter was left in situ with the hope that an epithelialized tract would result. Prophylactic antibi· otic treatment was initiated and continued for 5 days. During the postoperative course, a hysterosalpingogram through the indwelling catheter demonstrated a normal-shaped uterus with patent fallopian tubes. The patient was discharged on the fifth postoperative day without complications. The catheter remained positioned for 3 months, during which time three asymptomatic periods occurred with apparent good drainage. Ultrasonographic follow-up during this period did not reveal

Management of hematometrocolpos due to dysfunctional uterine bleeding following progestin use: a case report

“…Congenital abnormalities resulting in hematometrocolpos include imperforate hymen, a complete transverse vaginal septum, vaginal and, rarely, cervical atresia [7, 8, 9]. Acquired obstruction of the lower female genital tract is rare.…”

“…Uterine bleedings due to obstruction of the lower female genital tract cause proximal dilatation and the occurrence of hematocolpos, hematotrachelos or hematometra are the most common problems defined as congenital abnormalities [4, 5, 6]. Obstruction of the female genital outflow tract is rare [7, 8]. …”

Congenital absence of uterine cervix

“…Ultrasonography is the modality of choice to define the internal genital anatomy and helps us to classify the level of obstruction or aplasia. 7,8 The initial suspicion of cervical agenesis or dysgenesis can be easily done with ultrasonography in spite of its rare occurrence. Three dimensional ultrasound further improves our ability to accurately describe cervical anatomy though it requires operator expertise and adequate knowledge about the anatomical types.…”

Acute Spontaneous Hematotrachelos Following Methotrexate Treatment of a Suspected Tubal Pregnancy

“…Furthermore, sonographic documentation of this case over approximately 5 weeks (Figures 1 and 2) revealed the acute development of this lesion over a relatively short period in contrast to previously published reports of both congenital and acquired hematotrachelos. [1][2][3][4][5][6][7][8] …”