Priyatini Tyas
Urogynecology Division Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Urogynecology Division Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Int J Surg Case Rep. 2021 Jun;83:106032. doi: 10.1016/j.ijscr.2021.106032. Epub 2021 May 26.
We reported a case of common channel anomaly complicated with vaginal agenesis and rectal stone, which is a long-term complication of PSARP, a combination of very rare conditions with high morbidity and especially difficult treatment.
A 15-year-old female presented with a chief complaint of cyclic abdominal pain. The patient had no history of menstruation before. Physical examination showed a common channel. The diameter of the common channel was approximately 1 cm and 0.3 cm in length. A sound (±2 mm thickness) was inserted to the small opening between the urethra and anal mucosa with the length of the canal 6 cm. At the end of the opening, a stone-like structure was felt. The management of this case was abdominal hysterectomy with right salpingectomy and stone evacuation.
Cloacal malformation is thought to be associated with vaginal agenesis since both malformations are considered to have a similar pathophysiologic background. Treatment can be performed using posterior sagittal combined with laparotomy approach. After surgery, patients will need a long-term follow-up since the conditions may be associated with many possible urologic and gynecologic comorbidities, including recurrent urinary tract infections, hematosalpinx, and vesicourethral reflux, including stone formation.
Our case was considered one of the most complex common channel anomalies because it was complicated with a rare condition called vaginal agenesis and rectal stone after PSARP. A multidiscipline approach was necessary.
我们报告了一例共同通道异常合并阴道闭锁和直肠结石的病例，这是经会阴肛门直肠成形术（PSARP）的一种长期并发症，是多种极为罕见的病症的组合，发病率高且治疗难度极大。
一名15岁女性，主要症状为周期性腹痛。患者既往无月经史。体格检查发现一个共同通道。共同通道直径约1厘米，长度为0.3厘米。将一根（厚度±2毫米）探子插入尿道与肛门黏膜之间的小开口，通道长度为6厘米。在开口末端可触及一个结石样结构。该病例的治疗方法是腹式子宫切除术加右侧输卵管切除术及结石清除术。
泄殖腔畸形被认为与阴道闭锁有关，因为这两种畸形被认为具有相似的病理生理背景。可采用后矢状位联合剖腹术的方法进行治疗。手术后，患者需要长期随访，因为这些病症可能与许多可能的泌尿和妇科合并症相关，包括复发性尿路感染、输卵管积血和膀胱尿道反流，包括结石形成。
我们的病例被认为是最复杂的共同通道异常之一，因为它在PSARP术后合并了一种名为阴道闭锁和直肠结石的罕见病症。多学科方法是必要的。
