Uterine cervix agenesis - uterovaginal anastomosis

Abstract

Summary Purpose: Atresia of the uterine cerix is an uncommon Mullerian anomaly. Until ten years ago many authors recommended hysterectomy as the first line treatment in case of uterine cervix atresia. Recent advances in reproductive technology and laparoscopic surgical techniques mean that conservative surgery is a possibility and should be considered as the first line treatment option. Surgical treatment of uterine cervical atresia appears to be a good choice of treatment with good functional result. Materials and methology: We report a case of a 19-year-old woman who was admitted to our Department with amenorrhea and pelvic pain. Examination found no communication between vagina and uterus. The patient under general anesthesia was placed in a lithotomy position, allowing both abdominal (laparoscopy) and vaginal approach. A large dissection between the bladder and the uterus and later between the rectum and the uterus was performed. An incision was made on the uterine fundus and a probe to identify the upper limit of artretic tissue of the cervix was inserted. The atretic tissue was resected as for the cervical conisation until the uterine cavity was reached. Then the uterus was sutured to the high vaginal mucosa with separate stitches. A Foley catheter was inserted in the uterine cavity for 21 days. During the entire post-operative treatment the patient received antibiotics, oral contraceptives and vaginal douche. Four months after the surgery a hysteroscopic evaluation revealed that the communication between the uterus and the vagina was healed. Conclusions: The result of our surgery confirms that uterine atresia may be successfully treated by utero-vaginal anastomosis.