Uterine Didelphys with Transverse Vaginal Septum – A Complex rare Müllerian anomaly

Abstract

During the development of the female genital tract, any insult to the normal development process results in a set of intriguing abnormalities known as Müllerian duct abnormalities. The uterine didelphys is the second least common type of anomaly among these, which may commonly be associated with a longitudinal vaginal septum (lateral fusion defect). However uterine didelphys along with a transverse vaginal septum (lateral fusion plus resorption defect) is a very rare finding and to the best of our knowledge, thecase that we hereby report is the second one in literature.A 16-year-old unmarried girl presented with primary amenorrhoea and cyclical pain for 18months.On clinical examination and imaging, a case of uterine didelphys and transverse vaginal septum was found. Her urinary tract was normalon USG and MRI evaluation. Excision of the septum was done by abdomino-vaginal approach. The patient was discharged well.We conclude that a patient presenting with primary amenorrhea especially with cyclical dysmenorrhea with a transverse vaginal septum on examination should be thoroughly investigated for associated upper genital tract abnormalities as the treatment strategy and prognosis is largely dependent on the correct classification of the anomaly.

Bicornis unicollis uterus as a risk factor of preterm birth: A case of young woman with multiple premature births

“…Multiple malpositions of the ovaries and vagina can also occur [ 15 ]. Double vaginal manifestations include a longitudinal septum extending, completely or partially from cervix to introitus [ 16 , 17 , 18 ]. In 75% of these anomalies, complete longitudinal vaginal septum is present, although vaginal septa may also occur with other Mullerian duct anomalies [ 19 , 20 ].…”

Management of an isolated complete imperforate transverse vaginal septum: A case report

“…On ultrasonography, a hypoechoic crescent-shaped tissue with a swollen uterus full and upper cervix with blood or secretions (hematometrocolpos) may be seen, revealing the diagnosis. However, MRI has been advised for a thorough assessment of an obstructed vagina, as it can aid in the location and measurement of a septum for surgical repair [4] , [5] . In our case, transabdominal ultrasonography showed a significantly fluid intrauterine cavity and upper vaginal canal.…”

“…The diagnosis of the transverse vaginal septum is based on a careful clinical, gynecological examination and ultrasound scan via the abdominal or transrectal, if there are more complex cases, a magnetic resonance image (MRI) will be performed. If the diagnosis of hematometrocolpos is missed or delayed, which may develop retrograde menstruation which can cause subsequently endometriosis, pelvic adhesions, fallopian tube damage, and infertility [3] , [4] , [5] .…”