Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia; Division of Gynecologic Specialties, Emory University, Atlanta, Georgia; Division of Pediatric Surgery and Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia.
Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia.
J Pediatr Adolesc Gynecol. 2023 Aug;36(4):372-382. doi: 10.1016/j.jpag.2023.02.006. Epub 2023 Mar 4.
To describe cases of image-guided drainage of symptomatic hematometrocolpos from obstructive Müllerian anomalies as a temporizing measure to manage acute pain symptoms and delay definitive management of the obstructive Müllerian anomalies that require complex reconstruction METHODS: Institutional Review Board exemption from all included institutions was obtained. A retrospective case series from 3 academic children's hospitals of 8 females under the age of 21 with symptomatic hematometrocolpos due to obstructive Müllerian anomalies drained by image-guided percutaneous transabdominal vaginal or uterine drainage with interventional radiology was reviewed and described.
Eight pubertal patients with obstructive Müllerian anomalies (6 patients with distal vaginal agenesis, 1 patient with an obstructed uterine horn, and 1 patient with a high obstructed hemi-vagina) and symptomatic hematometrocolpos are reported. All patients with distal vaginal agenesis had greater than 3 cm lower vaginal agenesis, which would usually require complex vaginoplasty and use of postoperative stents. Given their immaturity and inability to use stents or dilators postoperatively or medical complexity, they subsequently underwent ultrasound-guided drainage of hematometrocolpos with interventional radiology to relieve pain symptoms, followed by menstrual suppression. The patients with obstructed uterine horns had complex medical and surgical histories requiring perioperative planning; they also underwent ultrasound-guided drainage of hematometra as a temporizing measure to manage acute symptoms.
Patients presenting with symptomatic hematometrocolpos due to obstructive Müllerian anomalies might not be psychologically mature enough to undergo definitive complex reconstruction, which requires vaginal stent or dilator use postoperatively to prevent stenosis and other complications. Image-guided percutaneous drainage of symptomatic hematometrocolpos serves as a temporizing measure by offering pain relief until patients are ready to undergo surgical management and/or to allow time for complex surgical planning.
描述因梗阻性 Müllerian 异常导致症状性血阴道积血行影像引导引流的病例，作为处理急性疼痛症状和延迟需要复杂重建的梗阻性 Müllerian 异常的暂定治疗方法。方法：获得所有纳入机构的机构审查委员会豁免。回顾性分析了 3 所学术儿童医院的 8 例年龄在 21 岁以下的因梗阻性 Müllerian 异常导致症状性血阴道积血的女性患者，这些患者通过影像引导经腹阴道或子宫穿刺引流联合介入放射学进行治疗，并对其进行了描述。结果：报告了 8 例因梗阻性 Müllerian 异常（6 例阴道下段发育不全，1 例阻塞性子宫角，1 例高位阻塞性半阴道）和症状性血阴道积血的青春期患者。所有阴道下段发育不全的患者阴道下段缺失大于 3cm，通常需要复杂的阴道成形术和术后使用支架。鉴于她们的不成熟以及无法在术后使用支架或扩张器或存在医学复杂性，她们随后接受了介入放射学引导的超声引导下血阴道积血引流，以缓解疼痛症状，随后进行月经抑制。阻塞性子宫角的患者有复杂的医疗和手术病史，需要围手术期计划；她们也接受了超声引导下的积血引流，作为一种暂时措施来处理急性症状。结论：因梗阻性 Müllerian 异常导致症状性血阴道积血的患者可能在心理上还不够成熟，无法进行复杂的重建，这需要术后使用阴道支架或扩张器以防止狭窄和其他并发症。症状性血阴道积血的影像引导经皮引流可作为一种临时措施，通过缓解疼痛，使患者准备好接受手术治疗和/或为复杂手术计划留出时间。
