Cervicovaginal atresia with hematometra: restoring menstrual and sexual function by utero-coloneovaginoplasty

Pediatr Surg Int. 2014 Oct;30(10):1051-60. doi: 10.1007/s00383-014-3550-6. Epub 2014 Jul 16.

Abstract

Background: Cervicovaginal atresia is a rare Mullerian anomaly. The management of cervicovaginal atresia has evolved from historical recommendations of hysterectomy to various reconstructive procedures more recently. The latter carries a risk of significant morbidity and unknown fertility. We present our experience in the management of this complex anomaly.

Methods: Twenty patients with cervicovaginal atresia were operated in our hospital from January 2004 through December 2013. The details of their anatomical variations and functional outcomes were analyzed.

Results: Eighteen out of twenty patients had cervical agenesis. Two patients had cervical hypoplasia. All patients underwent utero-coloneovaginoplasty. Post operatively, all patients have regular menstrual cycles. One patient is married, sexually active and has satisfactory coital function. One patient had a bowel anastomotic leak that required a diversion ileostomy. Two patients developed mild stenosis. One patient has mild neovaginal mucosal prolapse. No patient has developed pyometra.

Conclusion: Patients with cervicovaginal atresia need to be counselled about the various reconstructive options available and the potential risks. Social and economic factor play a significant role in determining the plan of management. For patients from conservative societies, utero-coloneovaginoplasty provides a safe conduit for the passage of menstrual flow and coitus, at the cost of permanent infertility.

MeSH terms

  • Adolescent
  • Adult
  • Anastomosis, Surgical / methods
  • Cervix Uteri / abnormalities*
  • Cervix Uteri / surgery
  • Child
  • Colon / surgery
  • Female
  • Hematometra / complications*
  • Hematometra / surgery
  • Humans
  • Menstruation*
  • Plastic Surgery Procedures / methods*
  • Postoperative Complications
  • Sexual Behavior*
  • Treatment Outcome
  • Uterus / surgery
  • Vagina / abnormalities*
  • Vagina / surgery
  • Young Adult