Moegni Fernandi, Meutia Alfa Putri, Kouwagam Anggrainy Dwifitriana, Hidayah Gita Nurul, Harzif Achmad Kemal
Urogynecology and Reconstruction Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Urogynecology and Reconstruction Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Int J Surg Case Rep. 2021 Aug;85:106166. doi: 10.1016/j.ijscr.2021.106166. Epub 2021 Jul 2.
Congenital or hypoplasia vaginal agenesis is a very rare condition caused by the failure of developmental Mullerian ducts. The prevalence is 0.001%-0.025% populations. This condition often misdiagnosed because the symptom does not appear. Acute symptoms such as abdominal pain may occur due to the obstruction of retrograde menstrual flow. In this case, we presented a case complex management of vaginal atresia with pyosalpinx, hematometra and bilateral hematosalpinx.
A 12 years old teenager, non-sexually active, complained cyclic abdominal pain that worsening in seven months before admission. Patient never had menstrual blood flow during her life. Patient was diagnosed with hematometra, hematocolpos, bilateral hematosalpinx and distal vaginal agenesis. Amnion graft neovagina was performed. Five days after surgery, patient started to have fever. On the seventh days after surgery, amnion graft was removed. The next two days patient still had fever. Because of continuous fever, patient was test of COVID 19. The result was positive. On the eleventh days after the first surgery, patient complained abdominal pain VAS 3-4. Patient was diagnosed with pyosalpinx by ultrasound examination. Laparotomy was done performing adhesiolysis, bilateral salpingectomy, and omentectomy.
In our case vaginal reconstruction surgery from vaginal approach has been done without management of the bilateral hematosalpinx because the consideration of small caliber of bilateral hematosalpinx. But then complications were developed when vaginal canal was opened, bilateral hematosalpinx were transformed into bilateral pyosalpinx and continue to developed into bilateral tubal abscess. We assume during this process, the bacteria from vagina could fastly infecting the blood and transformed it into pus and grew until tubal abscess.
The surgical intervention in vaginal agenesis must be considered as a treatment and not only focus on the reconstruction. Laparoscopy or laparotomy may offered as options for combination treatment with vaginal approach reconstructive surgery for vaginal agenesis with obstruction complications such as hematometra and hematosalpinx to prevent the worst condition like ascending infection or misdiagnosed other severe conditions.
先天性或发育不全性阴道闭锁是一种由苗勒管发育失败引起的非常罕见的病症。其在人群中的患病率为0.001% - 0.025%。这种病症常因无症状而被误诊。逆行月经血流受阻可能会出现腹痛等急性症状。在此，我们报告了一例合并输卵管积脓、子宫积血和双侧输卵管积血的阴道闭锁的复杂治疗病例。
一名12岁的青少年，无性活动，主诉入院前七个月周期性腹痛且逐渐加重。患者一生中从未有过月经来潮。患者被诊断为子宫积血、阴道积血、双侧输卵管积血和远端阴道闭锁。进行了羊膜移植阴道成形术。术后五天，患者开始发热。术后第七天，移除了羊膜移植片。接下来的两天患者仍有发热。由于持续发热，对患者进行了新冠病毒检测。结果呈阳性。首次手术后第十一天，患者主诉腹痛，视觉模拟评分（VAS）为3 - 4分。经超声检查，患者被诊断为输卵管积脓。进行了剖腹手术，包括粘连松解、双侧输卵管切除术和大网膜切除术。
在我们的病例中，由于考虑到双侧输卵管积血管径较小，经阴道途径进行了阴道重建手术，但未对双侧输卵管积血进行处理。但随后当阴道管开放时出现了并发症，双侧输卵管积血转变为双侧输卵管积脓，并继续发展为双侧输卵管脓肿。我们推测在此过程中，来自阴道的细菌可能迅速感染血液并将其转化为脓液，直至发展为输卵管脓肿。
阴道闭锁的手术干预必须被视为一种治疗手段，而不仅仅关注重建。腹腔镜检查或剖腹手术可作为与经阴道途径重建手术联合治疗阴道闭锁合并子宫积血和输卵管积血等梗阻并发症的选择，以防止出现上行感染或误诊为其他严重病症等最坏情况。
