Resectoscopic treatment of uterus didelphys with unilateral imperforate vagina complicated by hematocolpos and hematometra: case report

Objective: To describe a technique for treating hematocolpos and hematometr a in patients with uterus didelphys and unilateral imperforate vagina invol ving the use of resectoscopy under ultrasonographic control. Design: Case report. Setting: University hospital. Patient(s): A 13-year-old girl with uterus didelphys with unilateral hemato metra, hematocolpos, and ipsilateral renal agenesis. The girl complained of severe abdominal pain, which appeared with each of her menses. Intervention(s): The intervention was performed by a vaginoscopic approach to preserve the integrity of the hymen. The first incision on the vaginal w all was performed in correspondence with the hematocolpos under continuous ultrasonographic guidance with the use of a straight resectoscopic loop. Re section of the vaginal septum was continued with the use of an angled resec toscopic loop until almost complete excision of the septum was achieved. Main Outcome Measure(s): Clinical, echographic, and vaginoscopic findings b efore the operation and 2 and 6 months after the operation. Result(s): The surgical procedure was easy to perform. Almost complete exci sion of the septum was achieved with just a few passages of the resectoscop e. Complete drainage of both the hematocolpos and the hematometra was confi rmed by ultrasonography. The postoperative period was completely uneventful . Clinical and vaginoscopic evaluations 6 months after the operation confir med the integrity of the hymen, the complete resolution of clinical symptom s, and the persistence of a large communication between the two vaginas. Conclusion(s): Resectoscopic excision under ultrasonographic guidance of th e vaginal septum in a girl with uterus didelphys with unilateral hematometr a and hematocolpos was effective and easy to perform, and it fully respecte d the integrity of the reproductive system. (Fertil Steril(R) 1999;72:553-5 . (C) 1999 by American Society for Reproductive Medicine.).