Laparoscopic Management of Cervico Vaginal Agenesis in Rudimentary Horn Uterus With Pelvic Kidney, Two Step Approach

Abstract

Study Objective

Developmental anomalies involving mullerian or paramesonephric ducts represents some of the most fascinating disorders in Obstetrics and Gynaecology.

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

To present a two-step laparoscopic approach for the management of cervico-vaginal agenesis in rudimentary horn uterus with pelvic kidney in adolescent patients.

Design

A case report.

Setting

Pandit hospital and Laparoscopy centre, Ahmednagar, India.

Patients or Participants

A 15-year-old girl with primary amenorrhea and cyclical abdominal pain.

Interventions

MRI finding suggestive of right sided 5 × 3 × 2 cm rudimentary non communicating horn with vaginal agenesis.

Measurements and Main Results

Underwent a two-step laparoscopic procedure. The first step involved creating a vagina through meticulous dissection between the bladder and rectum, followed by the insertion of a specialized mold for vaginal dilation. Vaginoscopy was performed post-operatively to assess vaginal length and epithelialization. The second step involved mobilization of the right-sided uterine horn for central vagina anastomosis, utilizing various laparoscopic techniques including ligament dissection, broad ligament opening, ureterolysis, and careful fascial dissection.

The patient achieved significant vaginal length and proper epithelialization post-operatively. Menstrual regularity was achieved following the procedure, indicating successful functional restoration.

Conclusion

The two-step laparoscopic approach presented in this case offers a safe and effective method for managing cervico-vaginal agenesis in rudimentary horn uterus with pelvic kidney in adolescent patients. This approach minimizes morbidity and complications associated with traditional surgical techniques, providing a promising solution for this complex gynecological anomaly.