Laparoscopic Uterine Preservation and Vaginal Reconstruction in a 13-Year-Old Girl with Uterus Didelphys, Bilateral Vesicovaginal Fistulas, and Transverse Vaginal Septum - 27/03/24

Doi : 10.1016/j.jpag.2024.02.002

Grzegorz Kudela, MD, PhD ¹, Karolina Kowalczyk, MD, PhD ^2,^⁎ , Agnieszka Drosdzol-Cop, MD, PhD ³, Agnieszka Wiernik, MD ¹, Zbigniew Olczak, MD, PhD ⁴, Magdalena Górska, MD ⁵, Magdalena Machnikowska-Sokołowska, MD, PhD ⁴, Tomasz Koszutski, MD, PhD ¹
¹ Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
² Department of Endocrinological Gynecology, Medical University of Silesia, Katowice, Poland
³ Chair and Department of Gynecology, Obstetrics and Gynecological Oncology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
⁴ Department of Diagnostic Imaging, Medical University of Silesia, Katowice, Poland
⁵ Student Society at the Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland

^⁎Address correspondence to: Karolina Kowalczyk MD, PhD, Department of Endocrinological Gynecology, ul. Medyków 14, 40-752 Katowice, Poland; Phone 32 789 4351Department of Endocrinological Gynecologyul. Medyków 14Katowice40-752Poland

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 27 March 2024

Abstract

Background

Complex female genital tract malformations account for 1.2% of all female genitourinary malformations. Although exceedingly rare, they can cause severe gynecologic symptoms in young women and lead to fertility problems.

Case

We present the case of a 13-year-old girl with primary amenorrhea referred for cyclic abdominal lower pain and menouria. Detailed diagnostics revealed uterus didelphys, transverse vaginal septum, and bilateral vesicovaginal fistulas. Laparoscopic left hemi-hysterectomy and salpingectomy were performed. The vesicovaginal fistula on the right side was excised, and the proximal vagina was anastomosed with the distal dimple. Since the operation, the patient has been pain-free and menstruating regularly from the right uterus.

Summary and Conclusion

Preservation of the uterus should be considered in any case of complex female genital tract malformation and, as successful laparoscopic treatment advocates, a minimally invasive approach is feasible.

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Keywords : Menouria, Vesicovaginal fistula, Transverse vaginal septum, Uterus didelphys