An unusual case report of transverse vaginal septum presenting as primary amenorrhea

Abstract

Introduction and importance: Outflow tract disorders are uncommon causes of primary amenorrhea. Transverse vaginal septum (TVS) is a rare cause of outflow tract obstruction.

Case presentation: A 15-year-old female presented to us with severe abdominal pain. Abdominal examination revealed a boggy mass in the suprapubic region. The diagnosis was made following a history of primary amenorrhea, lower abdominal pain, and pelvic examination which revealed a vaginal septum. She had surgical resection of the vaginal septum and a mold was left in situ to keep the vagina patent during the healing process. The procedure was uneventful and she was able to achieve menstrual flow following surgery, septoplasty being performed after three months.

Discussion: Transverse vaginal septum is an unusual cause of primary amenorrhea. These lesions, albeit rare, usually have a typical presentation and are amenable to surgical management.

Conclusion: Although transverse vaginal septum is a rare diagnosis in our practice, it is important to establish early diagnosis and carry out proper management so as to preserve normal physiology and fertility as well as to prevent complications.

Keywords: Case report; Outflow tract disorder; Primary amenorrhea; TVS.

Fig. 1

MRI findings a) saggital, b) coronal showing loculated fluid collection with dependent layering, grossly distending the endocervical canal and vagina and displacing the uterus superiorly.

Fig. 2

Examination under anesthesia revealed a blindly ending vagina.

Fig. 3

Reveal of TVS after nick incision.

Fig. 4

MRI at one month post-procedure showing mild collection in the cervico-uterine cavity.

Fig. 5

Intraoperative image showing resection of the septum.