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• W1984240581 abstract "Mullerian duct anomalies occur in a variety of distinctive forms. Disorders of vertical fusion of mullerian ducts (AFS II) are due to defective fusion between the down growing mullerian ducts and upgrowing derivative of urogenital sinus (1). Of these defects a thick and high transverse vaginal septum, representing as a large segment of atretic vagina, and cervical agenesis or dysgenesis are most difficult to manage. Often an exploratory laparotomy and hysterotomy is necessary to guide a probe through the uterus and cervix to assist in locating a high hematocolpos (2). With the assistance of investigations like magnetic resonance imaging, CT scan and ultrasonography, the diagnosis in obstructive AFS II anomalies can be established before significant accumulation of blood in the uterus or vagina and its aftermath, like endometriosis (3). However, technically the surgical procedure is difficult in these cases due to absence of the mass resulting from accumulated menstrual blood which dissects off the bladder anteriorly and rectum posteriorly. Various authors have suggested methods to minimize the technical difficulties encountered during surgery and optimize the outcome (4). We suggest a method of artificially creating a collection in the uterus, cervix and vagina (chromatometra or chromatocolpos), depending on the site of obstruction, by injecting a dye (methylene blue) through the uterus on laparotomy in order to facilitate the surgical procedure in patients with a small collection of menstrual blood high up. A 14 year old, unmarried healthy girl presented to outpatient department of Obstetrics and Gynaecology of Lady Hardinge Medical College and Associated Hospital, New Delhi with complaints of intermittent colicky and painful abdomen gradually increasing for 3 days and which subsided after treatment. There were no associations, relieving or aggravating factors. She had a similar episode a month back. She had not attained menarche as yet. On examination, her height and built was average. Secondary sexual characteristics were well developed for her age. The external genitalia were normal. On separating the labia the hymen was normal. It was neither congested nor bulging. Vaginal opening was absent. On per rectal examination a soft cystic mass 3 cm×3 cm was felt 4 cm above the anal orifice deviated to the left. A firm mass? uterus was felt on the top of this mass. All routine investigations were normal. There was no evidence of tuberculosis. On ultrasound examination the uterus was normal in size and echotexture. Minimal fluid collection was seen in the endometrial cavity. The cervical canal was open, with evidence of collection of fluid measuring 2×1.9cm. Bilateral tubes and ovaries were normal. There was no fluid in the Pouch of Douglas. On diagnostic laparoscopy, the uterus was bulky, both tubes and ovaries were normal. Small endometriotic patches were seen on the posterior surface of the uterus and right parametrium. A provisional diagnosis of vertical fusion defect of mullerian ducts AFS II with vaginal atresia was made. Decision for drainage of hematometra with vaginoplasty was taken. A transverse incision was made through the mucosa of vaginal vestibula. The space between urethra and bladder anteriorly and rectum posteriorly was dissected. The mass (3 cm×3 cm) felt on initial per rectal examination had reduced in size by now and could not be approached through the dissected space. It was felt to be anterior to the dissected space. Exploratory laparotomy was decided upon and 50–60 cc. of methylene blue was injected into the uterine cavity after blocking the cornual ends of the tubes. The cervix was dilated with dye and endocervical canal could now be entered from below through the dissected space. The dye, mixed with menstrual blood, was drained. The cervix was dilated and was 4.5 cm long. Uterocervical length was 7cm. A final diagnosis of cervical dysgenesis (stenosis of external os) with vaginal aplasia was made. The cervix was stitched all around with a continuous locking stitch. Two silk stitches were applied at 3 and 9 o’clock position of cervix and the threads were left long, through the opening in the vaginal mould to facilitate identification of the cervix subsequently. A vaginal mould covered with split thickness skin graft was introduced in the dissected space. The postoperative period was uneventful. At the time of discharge the vagina was well formed. Uterus and cervix appeared to be normal. Subsequently the patient had normal periods. She is continuing to use the mould and has had regular periods for the past one year now. Obstructed mullerian duct anomalies present soon after onset of puberty. Of these patients, those with a large segment of vagina absent or atretic and or those having cervical obstruction present very early. These are most difficult to manage due to technical difficulty in approaching the hematometra from below which is usually very small in size. Often an exploratory laparotomy with hysterotomy is required to guide a probe or dilator through the uterus and cervix to assist in locating a small and high hematometra or hematocolpos (2). To avoid accidental incision into the bladder or rectum, creation of an artificial fluid accumulation in the uterus, cervix or vagina is suggested so that the cervix or the vagina can be safely approached from below without making an opening in the uterus. This is useful to facilitate the surgery, thereby reducing risks of complications." @default.
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• W1984240581 date "2001-04-01" @default.
• W1984240581 modified "2023-09-27" @default.
• W1984240581 title "Chromatometra or chromatocolpos - technical considerations in the management of obstructed mullerian duct anomalies" @default.
• W1984240581 cites W2063266129 @default.
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• W1984240581 doi "https://doi.org/10.1034/j.1600-0412.2001.080004375.x" @default.
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