Laparoscopic Management of Cervical Agenesis: A Rare Case Report

Abstract

Study Objective

To present the successful laparoscopic management of a rare case of congenital obstructive Mullerian anomaly, identified as partial vaginal aplasia and cervical agenesis.

Design

Description of the surgical steps involved in performing a direct laparoscopic utero-vaginal anastomosis to restore the continuity of the genital tract, with a 2-year follow-up.

Setting

Clinical examination and laparoscopy were performed under general anesthesia.

Patients or Participants

A 13-year-old girl was referred for management of cyclic pelvic pain. Despite not having reached menarche, she exhibited secondary sexual characteristics.

Magnetic resonance imaging revealed the presence of a uterus with a large hematometra measuring 6.4 × 5.2cm. However, imaging could not conclusively confirm the presence of a proximal vagina and a cervix.

Due to the failure of hormonal and analgesic therapy to alleviate severe pain, the patient final underwent a mini-invasive surgical procedure.

Interventions

The external genitalia appeared normal. A 2cm vaginal cul-de-sac was identified with the absence of the upper two-thirds of the vagina. We were able to gently manually dilated it in order to reach the bulging collection.

Laparoscopy revealed endometriotic peritoneal lesions with widespread deposits of siderin throughout the abdominal cavity. An enlarged uterus with a hugely dilated isthmic portion (hematometra) was confirmed.

Measurements and Primary Results

The patient experienced immediate relief post-operatively. Two months later, an elective vaginoscopy revealed a 3cm long vagina with a permeable opening at the level of the anastomosis. Hysteroscopy indicated an endocervical canal, still dilated, with the presence of mucus. Passage through the endocervix allowed visualisation of a uterus presenting a partial septum. Repeated hysteroscopy at 5 months showed no stenosis and patient reported normal menstrual cycles after 2-year follow-up.

Conclusion

Cervical agenesis can be effectively managed conservatively, with long-term success achievable using a direct laparoscopic utero-vaginal anastomosis.