Mullerian anomalies arise from the failure in the development of Mullerian ducts and their associated structures during organogenesis which confers adverse impact in fertility and reproductive health. Presented is a rare case of a 15 year old nulligravid, who presented with a chief complaint of severe cyclic hypogastric pain associated with primary amenorrhea. Complete clinical history, physical examination and sonographic findings pointed to a diagnosis of cervical hypoplasia associated with functioning uterine corpus and an absent vagina. Patient underwent total abdominal hysterectomy with left salpingectomy and bilateral oophorocystectomy, for hematometra, bilateral endometriotic cysts, and hematosalpinx. This case report discusses the management of cervicovaginal agenesis through a multidisciplinary approach by a team composed of an obstetrician-gynecologist, reproductive endocrinologist, pediatrician, and pediatric surgeon for proper evaluation, diagnosis, and management of this case.
Hematometra

Congenital anomalities of the vagina are rare congenital anomalies. Women born with this anomaly present with collection of blood in the uterine cavity or hematometra and pelvic pain. Presented is a case of a 12-year old girl with hypogastric pain and primary amenorrhea complicated by vaginal agenesis. She was managed conservatively by creating a neovagina with the use of bipudental flap or Modified Singapore flap. Management can be non-surgical or surgical but the management of congenital vaginal agenesis remains controversial. The decision to do a conservative surgical procedure or a hysterectomy depends on the clinical profile of the patient, the expertise of the surgeons, the extent of the anomaly, and it's association to other congenital anomalies.

Human ; Female ; Child ; Hematometra ; Vagina, Absence Of ; Amenorrhea ; Vagina ; Hysterectomy ; Pelvic Pain ; Surgeons

Congenital absence of the uterine cervix and vagina in the presence of a functional endometrium is an extremely rare congenital anomaly. Women born with this anomaly present with collection of blood in the uterine cavity or hematometra, disabling pelvic pain and progressively worsening endometriosis. Presented is a case of a 16 year-old girl with severe pelvic endometriosis and hematometra complicated by cervicovaginal agenesis. She was managed by total abdominal hysterectomy with bilateral salpingectomy, left oophorocystectomyandadhesiolysis. Surgical management of congenital cervicovaginal agenesis remains controversial. The decision to do a conservative surgical procedure or a hysterectomy depends on the clinical profile of the patient, the expertise of the surgeon, the extent of the malformation and its association with other mullerian anomalies.

Human ; Female ; Adolescent ; abnormalities ; Endometriosis ; Female Urogenital Diseases and Pregnancy Complications ; Hematometra

Cervical stenosis is a challenging condition that often recurs despite intervention. Multiple therapeutic options have been described, but a clearly effective and reliable treatment method has yet to be identified. Patients with recurrent stenosis are at risk of developing severe complications such as chronic pelvic pain and infertility. We describe a case of congenital cervical stenosis with secondary haematometra in which repeated cervical dilatation, hysteroscopic canalisation and administration of medications to retard endometrial development were unsuccessful in relieving the obstruction and preventing re-accumulation of menstrual blood. Total hysterectomy was eventually mandated by spontaneous rupture of the haematometra.
Adult ; Constriction, Pathologic ; complications ; diagnosis ; Endometrium ; pathology ; Female ; Hematometra ; complications ; diagnostic imaging ; surgery ; Humans ; Infertility ; Pelvic Pain ; Recurrence ; Risk ; Rupture, Spontaneous ; complications ; Tomography, X-Ray Computed ; Uterine Cervical Diseases ; complications ; diagnosis ; Uterine Diseases ; complications ; diagnosis ; Uterine Hemorrhage ; complications ; diagnosis ; Uterine Rupture ; diagnostic imaging ; etiology ; surgery

A 24 year-old patient, single, with cervical agenesis and imperforate hymen is presented. She underwent hymenectomy for hematosalpinx and right oophorectomy for endometriosis, before finally undergoing hysterectomy. Cervical agenesis is a rare anatomic developmental abnormality and proposed guidelines in managing similar conditions are reviewed in this report. The management of choice will defend on the condition of the patient and the availability of resources. The patient underwent multiple surgeries in the past. However, despite all efforts to address her medical condition, due to the complications, the small chance of getting pregnant, and the absence of an experienced surgeon capable of performing a reconstructive procedure, she was eventually convinced to undergo hysterectomy. With cervical agenesis, the patient is faced with psychological difficulties that should be addressed. One can only hope that the future will hold a more optimistic outlook for young girls with this rare congenital abnormality.
Human ; Female ; Young Adult ; ABNORMALITIES ; HEMATOMETRA ; HEMATOCOLPOS ; HYSTERECTOMY

OBJECTIVETo establish the diagnosis scale of blood stasis syndrome (BSS) and explore the idea and method of using scale to research the quantitative diagnosis of Chinese medicine (CM) syndrome.

METHODSCombining the modern epidemiology, consulting the access of quality of life scale, and colligating multi-angle methods to make the scale.

RESULTSThe scale had relatively good reliability and validity and could be used to estimate the degree of stasis and analyse the curative effect.

CONCLUSIONSIt was a reference for CM syndrome diagnosis that combines screening methods of scale entry with quantitative diagnosis to establish the quantitative diagnosis scale.

Aged ; Aged, 80 and over ; Coronary Disease ; complications ; diagnosis ; epidemiology ; Diabetes Mellitus, Type 2 ; complications ; diagnosis ; epidemiology ; Diagnosis, Differential ; Female ; Hematologic Diseases ; diagnosis ; epidemiology ; therapy ; Hematometra ; complications ; diagnosis ; epidemiology ; Humans ; Hypertension ; complications ; diagnosis ; epidemiology ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Reproducibility of Results ; Surveys and Questionnaires ; Syndrome

Vaginal agenesis is an uncommon congenital anomaly and such complex malformations are usually incorrectly identified. Deviations from the normal embryologic events in the reproductive system may result to malformations which may exhibit with the same clinical presentation. A complete history and physical examination coupled with appropriate imaging techniques are necessary to arrive at a correct diagnosis. Physicians must be aware of the differential diagnosis and management options available. A correct diagnosis must be made prior to any surgical intervention to prevent inappropriate surgeries with their anticipated complications. In cases with vaginal outlet obstruction, an accurate diagnosis with the adequate treatment reduces the need for re-operations and subsequent complications. Reported are three misdiagnosed cases of distal vaginal agenesis resulting to unwarranted surgical interventions.
Human ; Female ; Adolescent ; ABNORMALITIES ; VAGINA ; HEMATOCOLPOS ; HEMATOMETRA ; ROKITANSKY KUSTER HAUSER SYNDROME

A not so benign disease of imperforate hymen in a 20 year old who presented with acute hypogastric pain will be discussed. The diagnosis of an imperforate hymen should be made during routine neonatal pediatric examination. However, it is not unusual to see a teenage girl present with typical findings of cyclic adominal pain, urinary retention, constipation and a bulging introital mass with hematocolpos and hematometra on ultrasounds examination. Additional findings may include hematosalpinges and formation of endometrial cysts with severe pelvic adgesions. Conservative management generally includes hymenectomy with drainage of the blood and antibiotic therapy. Patients are generally discharged after 24 hours or the procedure is done as an outpatient basis with oral pain medications given. However in our case, the dilemma in terms of management of conservative versus aggressive surgery was encountered. Our patient was only 20 years old presenting with primary amenorrhea and cyclic dysmenorrhea for 7 years with the possibility of a pelvic "clean up" and the problems of premature menopause and infertility were at the back of our minds. A greater awareness of this complication should prompt clinicians to consider this entity when dealing with cases such as this one.
Human ; Female ; Young Adult ; HEMATOCOLPOS ; HEMATOMETRA ; VAGINA ; HYMEN

Adult ; Female ; Hematometra ; pathology ; Humans ; Uterine Neoplasms ; pathology ; Uterus ; pathology

The incidence of all transverse vaginal septum is 1:2,100 - 1:72,000. The transverse vaginal septum is a developmental defect of vagina which may be fused incompletely between the Mullerian duct component and the urogenital sinus component of vagina. Serious complications may be hematocolpos, hematometra and hematosalpinx. Simple surgical excision or simple incision have been developed to treat congenital transverse vaginal septa, but also caused common complications such as secondary tissue contracture. Garcia technique using eight vaginal mucosa flaps was developed to avoid common complication of secondary vaginal stenosis. Here, we present a case of contracted transverse vaginal septum who has been performed a simple incision 13 years ago, successfully performed the modified Garcia technique without serious postoperative complication.
Constriction, Pathologic ; Contracture ; Female ; Hematocolpos ; Hematometra ; Incidence ; Mucous Membrane ; Postoperative Complications ; Vagina