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Vaginal reconstruction for distal vaginal atresia without anorectal malformation: is the approach different?
Pediatr Surg Int 2019; 35(9):963-966PS

Abstract

INTRODUCTION

Distal vaginal atresia is a rare condition and treatment approaches are varied, usually driven by symptoms.

METHODS

A retrospective review was performed to identify patients with distal vaginal atresia without anorectal malformation. Data collected included age and symptoms at presentation, type and number of operations, and associated anomalies.

RESULTS

Eight patients were identified. Four presented at birth with a hydrocolpos and four presented with hematometrocolpos after 12 years of age. Number of operations per patient ranged from one to seven with an average of three. The vaginal reconstruction was achieved by perineal vaginal mobilization in four patients and abdomino-perineal approach in four patients. One patient, with a proximal vagina approximately 7 cm from the perineum, required partial vaginal replacement with colon. In addition, she had hematometrocolpos with an acute inflammation at the time of reconstruction despite menstrual suppression and drainage which may have contributed to the difficulty in mobilizing the vagina. In five patients, distal vaginal atresia was an isolated anomaly. In the other three cases, associated anomalies included: mild hydronephrosis that improved after hydrocolpos decompression (2), cardiac anomaly (2), and vertebral anomaly (1).

CONCLUSION

In this series, a distended upper vagina/uterus was a common presentation and the time of reconstruction was driven by the presence of symptoms. Drainage of the hydrocolpos/hydrometrocolpos with menstrual suppression in post-pubertal patients, followed by further work-up, and planned reconstruction is a good surgical strategy.

Authors+Show Affiliations

Department of Pediatric Surgery, Children's Hospital Colorado, International Center for Colorectal and Urogenital Care, University of Colorado, 13123 East 16th Avenue Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA. andrea.bischoff@childrenscolorado.org.Division of Pediatric and Adolescent Gynecology, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA.Department of Pediatric Surgery, Children's Hospital Colorado, International Center for Colorectal and Urogenital Care, University of Colorado, 13123 East 16th Avenue Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA.Department of Pediatric Surgery, Children's Hospital Colorado, International Center for Colorectal and Urogenital Care, University of Colorado, 13123 East 16th Avenue Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31256298

Citation

Bischoff, Andrea, et al. "Vaginal Reconstruction for Distal Vaginal Atresia Without Anorectal Malformation: Is the Approach Different?" Pediatric Surgery International, vol. 35, no. 9, 2019, pp. 963-966.
Bischoff A, Alaniz VI, Trecartin A, et al. Vaginal reconstruction for distal vaginal atresia without anorectal malformation: is the approach different? Pediatr Surg Int. 2019;35(9):963-966.
Bischoff, A., Alaniz, V. I., Trecartin, A., & Peña, A. (2019). Vaginal reconstruction for distal vaginal atresia without anorectal malformation: is the approach different? Pediatric Surgery International, 35(9), pp. 963-966. doi:10.1007/s00383-019-04512-2.
Bischoff A, et al. Vaginal Reconstruction for Distal Vaginal Atresia Without Anorectal Malformation: Is the Approach Different. Pediatr Surg Int. 2019;35(9):963-966. PubMed PMID: 31256298.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vaginal reconstruction for distal vaginal atresia without anorectal malformation: is the approach different? AU - Bischoff,Andrea, AU - Alaniz,Veronica I, AU - Trecartin,Andrew, AU - Peña,Alberto, Y1 - 2019/06/29/ PY - 2019/06/20/accepted PY - 2019/7/1/pubmed PY - 2019/7/1/medline PY - 2019/7/1/entrez KW - Agenesis of the lower vagina KW - Distal vaginal atresia KW - Hydrocolpos KW - Hydrometrocolpos KW - Imperforate hymen KW - Transverse vaginal septum SP - 963 EP - 966 JF - Pediatric surgery international JO - Pediatr. Surg. Int. VL - 35 IS - 9 N2 - INTRODUCTION: Distal vaginal atresia is a rare condition and treatment approaches are varied, usually driven by symptoms. METHODS: A retrospective review was performed to identify patients with distal vaginal atresia without anorectal malformation. Data collected included age and symptoms at presentation, type and number of operations, and associated anomalies. RESULTS: Eight patients were identified. Four presented at birth with a hydrocolpos and four presented with hematometrocolpos after 12 years of age. Number of operations per patient ranged from one to seven with an average of three. The vaginal reconstruction was achieved by perineal vaginal mobilization in four patients and abdomino-perineal approach in four patients. One patient, with a proximal vagina approximately 7 cm from the perineum, required partial vaginal replacement with colon. In addition, she had hematometrocolpos with an acute inflammation at the time of reconstruction despite menstrual suppression and drainage which may have contributed to the difficulty in mobilizing the vagina. In five patients, distal vaginal atresia was an isolated anomaly. In the other three cases, associated anomalies included: mild hydronephrosis that improved after hydrocolpos decompression (2), cardiac anomaly (2), and vertebral anomaly (1). CONCLUSION: In this series, a distended upper vagina/uterus was a common presentation and the time of reconstruction was driven by the presence of symptoms. Drainage of the hydrocolpos/hydrometrocolpos with menstrual suppression in post-pubertal patients, followed by further work-up, and planned reconstruction is a good surgical strategy. SN - 1437-9813 UR - https://www.unboundmedicine.com/medline/citation/31256298/Vaginal_reconstruction_for_distal_vaginal_atresia_without_anorectal_malformation:_is_the_approach_different L2 - https://doi.org/10.1007/s00383-019-04512-2 DB - PRIME DP - Unbound Medicine ER -