Name
12277 - Hysteroscopic Approach to a Complete Septate Uterus and Obstructed Left Hemivagina
Presenting Author
Brenda Soares Santos
Affiliation
Irmandade Santa Casa de Misericórdia de São Paulo
Abstract
- Study Objective: To describe a rare case of Müllerian malformation.
- Design: The study was developed containing didactic illustration of the variant and clinical information that led to diagnostic suspicion. The investigation involved imaging exams that aided in the hysteroscopic surgical planning.
- Setting: The Müllerian malformation was identified based on the classification of the American Society for Reproductive Medicine 2021, allowing it to be related to symptoms and possible variants for the best therapeutic proposal.
- Patients or Participants: A fifteen-year-old adolescent with complaints of severe dysmenorrhea since menarche associated with intense acyclic pelvic pain. Vaginal examination was not performed due to the patient being a virgin. Pelvic magnetic resonance imaging revealed complete septate uterus, obstructed left hemivagina, ipsilateral renal agenesis, and deep endometriosis of the posterior compartment.
- Interventions: Surgery was initiated laparoscopically, identifying endometriotic lesions in the retrocervical region and uterosacral ligaments, which were resected after identification of the ureters and hypogastric nerves. Vaginoscopic hysteroscopy revealed the cervix deviated to the right and bulging of the left vaginal fornix. The left external cervical orifice was identified after complete resection of the vaginal septum, allowing access for hysteroscopic metroplasty with a resectoscope. The uterine septum was completely resected by hysteroscopy with laparoscopic visualization without complications.
- Measurements and Main Results: The procedure lasted 2 hours with good postoperative evolution. After discharge, transdermal Estradiol was started associated with Progesterone. At the first follow-up, the adolescent reported complete improvement in pelvic pain. After menstruation, hysteroscopy second-look was performed with no evidence of uterine synechiae.
- Conclusion: Clinical history and pelvic magnetic resonance imaging were essential for diagnostic suspicion and surgical planning. Laparoscopic visualization during hysteroscopy was essential for both diagnostic confirmation and to allow total resection of the uterine septum. Patient follow-up with hysteroscopy second-look without synechiae and improvement in pelvic pain confirmed the effectiveness of the chosen treatment.
Authors
Soares Santos, BI*1, Fonseca Rezende, R2, Ohara, F3, Cervantes, G2, Salomão, H3, Ayroza, P3. 1Gynecological Endoscopy and Endometriosis Sector, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil; 2Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil; 3Gynecological Endoscopy And Endometriosis Division, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
Primary Category
Hysteroscopy
Secondary Category
Pelvic Pain
Sponsorship Level
Virtual Poster