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    Mullerian Agenesis: An Unusual Presentation As Hematometra and Bilateral Hematosalpinx

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    This document describes a case study of a 15-year-old girl who presented with abdominal pain and a pelvic mass. She was diagnosed with Mullerian agenesis, or an absence of the uterus, cervix, and upper vagina. Specifically, she had a bicornuate uterus with hematometra (blood in the uterus) and bilateral hematosalpinx (blood in the fallopian tubes). She underwent an abdominal hysterectomy to remove the malformed uterus and bilateral salpingectomy to remove the fallopian tubes, while conserving the ovaries. The case highlights the need to consider rare Mullerian duct anomalies in adolescents presenting with cyclical abdominal pain.

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    Mullerian Agenesis: An Unusual Presentation As Hematometra and Bilateral Hematosalpinx

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    wanwan_adong
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    This document describes a case study of a 15-year-old girl who presented with abdominal pain and a pelvic mass. She was diagnosed with Mullerian agenesis, or an absence of the uterus, cervix, and upper vagina. Specifically, she had a bicornuate uterus with hematometra (blood in the uterus) and bilateral hematosalpinx (blood in the fallopian tubes). She underwent an abdominal hysterectomy to remove the malformed uterus and bilateral salpingectomy to remove the fallopian tubes, while conserving the ovaries. The case highlights the need to consider rare Mullerian duct anomalies in adolescents presenting with cyclical abdominal pain.

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    This document describes a case study of a 15-year-old girl who presented with abdominal pain and a pelvic mass. She was diagnosed with Mullerian agenesis, or an absence of the uterus, cervix, and upper vagina. Specifically, she had a bicornuate uterus with hematometra (blood in the uterus) and bilateral hematosalpinx (blood in the fallopian tubes). She underwent an abdominal hysterectomy to remove the malformed uterus and bilateral salpingectomy to remove the fallopian tubes, while conserving the ovaries. The case highlights the need to consider rare Mullerian duct anomalies in adolescents presenting with cyclical abdominal pain.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    30 views2 pages

    Mullerian Agenesis: An Unusual Presentation As Hematometra and Bilateral Hematosalpinx

    Uploaded by

    wanwan_adong
    This document describes a case study of a 15-year-old girl who presented with abdominal pain and a pelvic mass. She was diagnosed with Mullerian agenesis, or an absence of the uterus, cervix, and upper vagina. Specifically, she had a bicornuate uterus with hematometra (blood in the uterus) and bilateral hematosalpinx (blood in the fallopian tubes). She underwent an abdominal hysterectomy to remove the malformed uterus and bilateral salpingectomy to remove the fallopian tubes, while conserving the ovaries. The case highlights the need to consider rare Mullerian duct anomalies in adolescents presenting with cyclical abdominal pain.

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    © All Rights Reserved
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    of 2

    OBSTETRICS AND GYNECOLOGY

    Mullerian Agenesis: An Unusual Presentation as


    Hematometra and Bilateral Hematosalpinx
    GUPTA S*, KUMARI A†

    ABSTRACT
    A case of hematometra with bicornuate uterus and bilateral hematosalpinx in a 15-year-old girl complicated by vaginal agenesis
    and absent cervix is presented. She was managed by abdominal hysterectomy and bilateral salpingectomy. Bilateral ovaries
    were conserved.
    Keywords: Mullerian agenesis, hematometra, hematosalpinx

    M
    ullerian agenesis occurs in 1 out of every noncontributory. Per vaginal examination was not
    4,000–10,000 females.1 The independent carried as she was unmarried.
    occurrence of congenital hematometra
    All routine examinations revealed no obvious
    without hematocolpos is a rare mullerian duct anomaly
    abnormality. An ultrasound scan of pelvis and abdomen
    that results from a noncommunicating rudimentary
    revealed hematometra with bilateral hematosalpinx.
    horn with functioning endometrium or primary cervical
    Computed tomography scan showed thick-walled
    atresia and absent upper vagina.2–4 Women affected by
    cystic lesion in left lumbar region continuous with
    this disorder often have accompanying renal, skeletal,
    and other anomalies.5 hematometra. Examination under anesthesia revealed
    a blind lower vagina of 2 cm. On rectal examination,
    We report a case of bicornuate uterus with hematometra tense and firm mass was felt.
    and bilateral hematosalpinx in a 15-year-old girl who
    presented with acute abdominal pain and 6 × 4 cm A diagnostic laparoscopy was performed that revealed a
    pelviabdominal mass (Fig. 1). bicornuate uterus with hematometra; bilateral fallopian
    tubes were distended and bluish in color suggestive of
    CASE REPORT hematosalpinx. Both ovaries were normal. Stick-like
    band was seen between lower half of both mullerian
    A 15-year-old unmarried female presented with ducts.
    complaint of primary amenorrhea with cyclical
    abdominal pain for past 12 months. Pain was relieved
    by oral analgesics. There were no bladder or bowel
    complains. Her general and systemic examinations
    were within normal limits. Examination per
    abdomen revealed a firm, well-defined, nontender,
    noncompressible, and nonreducible mass measuring
    6 × 4 cm in left iliac fossa. Per rectal examination was

    *Antenatal Medical Officer and Lecturer


    †Senior Resident

    Dept. of Obstetrics and Gynecology


    BRD Medical College Gorakhpur, Uttar Pradesh
    Address of correspondence
    Dr Ankita Kumari
    H. No. 727, Anand Vihar Colony
    Rapti Nagar, Arogya Mandir
    Gorakhpur, Uttar Pradesh-273 003 Figure 1. Intraoperative photograph showing bicornuate
    E-mail: drankita09@gmail.com uterus with hematometra and bilateral hematosalpinx.

    Indian Journal of Clinical Practice, Vol. 24, No. 7, December 2013 655
    OBSTETRICS AND GYNECOLOGY

    On laparotomy, bilateral hematosalpinx with bilateral CONCLUSION


    normal ovaries and distended bicornuate uterus was
    found. The lower part of uterus, cervix, and upper When one encounters blocked uterus, it should be
    three-fourth of vagina were not formed. Routine thoroughly evaluated especially in adolescents with
    hysterectomy along with removal of both fallopian relevant investigations keeping in mind the rare
    tubes was done. Both ovaries were conserved. The possibility of mullerian anomaly. Early diagnosis
    patient had an uneventful postoperative recovery. Her and prompt treatment is recommended in these
    stitches were removed on the eight postoperative day patients to avoid future gynecological and obstetrical
    and she was allowed to go home the same day. complications. Although technical advances favor
    reconstructive surgery for cervicovaginal agenesis, it
    DISCUSSION
    must be emphasized that these complex procedures are
    Complete cervicovaginal agenesis with a functioning not without complications resulting in recurrence of
    endometrium in a bicornuate uterus is an extremely hematometra ultimately requiring hysterectomy. In this
    rare mullerian duct malformation.6 Only few cases of patient, the decision for hysterectomy was considered
    such abnormality have been reported along with their most appropriate to suit her social circumstances.
    surgical procedures.
    This 15-year-old girl had cyclical abdominal pain for REFERENCES
    last 12 months. As she was in perimenarchal age and
    1. Envans TN, Poland ML, Boving RL. Vaginal malformations.
    presented with an abdominal mass, it was suspected to
    Am J Obstet Gynaecol 1981;141:910-20.
    be due to cryptomenorrhea resulting from entrapped
    menstrual blood in the uterine cavity causing pain. 2. Rana A, Gurung G, Begum SH, Adhikari S, Neupane BB.
    A pelviabdominal ultrasound showed hematometra. Hysterectomy for hematometra in a 15 years-old mentally
    Diagnostic laparoscopy confirmed bicornuate uterus handicapped girl with congenital cervicovaginal agenesis
    with bilateral hematosalpinx with absent cervix and and concomitant ovarian adenoma. J Obstet Gynaecol Res
    upper vagina. 2008;34(1):105-7.

    Our case emphasizes that mullerian anomalies should 3. Garat JM, Martinez E, Aragona F, Gosalbez R. Cervical
    urinary atresia with hematometra: a rare case of urinary
    be considered among the differential diagnosis of
    retention in a girl. J Urol 1984;132(4):772-3.
    cyclical abdominal pain that responds poorly to
    analgesics. As developmental anomalies of urinary and 4. Khunda SS, Al-omari S. A new approach in the
    mullerian tracts are commonly associated, the former management of lower mullerian atresia. J Obstet Gynaecol
    anomalies should be specifically investigated before 1998;18(6):566-8.
    elective surgery is carried out. 5. Miller PB, Forstein DA. Creation of a neovagina by the
    The general consensus of treatment of these patients has Vecchietti procedure in a patient with corrected high
    been to remove the mullerian structures during initial imperforate anus. JSLS 2009;13(2):221-3.
    operation so as to avoid postoperative complications. 6. Gurbuz A, Karateke A, Haliloglu B. Abdominal surgical
    The same principle of treatment was applied in the approach to a case of complete cervical and partial vaginal
    case described. agenesis. Fertility Sterility 2005;84(1):217.

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    656 Indian Journal of Clinical Practice, Vol. 24, No. 7, December 2013

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