Interventional Radiology Guided Excision of Proximal Oblique Vaginal Septum in Pediatric Patient with Ohvira

Abstract

Study Objective

Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) typically manifests as a didelphys uterus with an oblique vaginal septum on the same side as the renal anomaly and often presents around the time of menarche. The oblique septum obstructs menstrual egress from one cervix, leading to hematocolpos and distension of the obstructed hemivagina; thus, treatment of OHVIRA requires resection of the vaginal septum. A proximal septum may be more difficult to safely resect due to lack of distention to delineate borders.

Design

Single patient video of excision procedure

Setting

Tertiary care pediatric hospital in United States

Patients or Participants

13-year-old female with known absent right kidney.

Interventions

Vaginal septum resection using Interventional Radiology techniques to adequately identify and distend the obstructed hemivagina for safe resection.

Measurements and Primary Results

Safe excision of oblique septum obstructing hemivagina, confirmed on vaginoscopy.

Conclusion

The resection and repair of OHVIRA can be challenging when the level of obstruction is high with lack of distention to delineate the obstructed hemivagina. Concurrent use of fluoroscopy and ultrasonographic guidance can allow for definitive confirmation of the space and provide a helpful guide for safe repair.