An Incompletely Resected, Obstructing Longitudinal Vaginal Septum Causing Copious Mucus Discharge

Abstract

Objectives: To describe a case report of the surgical findings and repair of a patient presenting with a uterine didelphys associated with copious vaginal discharge status post a previous surgery for a left hydrometrocolpos. Design: A case report. Materials and Methods: Review of the Medline literature from 1966–2000. Results: A 10 year old nulligravid, premenarchal patient presented elsewhere with severe abdominal pain and an abdominal mass. She was found to have a suspected uterine didelphys with a left hydrometrocolpos and a solitary right kidney. This diagnosis was based on ultrasound and magnetic resonance imaging (MRI). The patient was taken to the operating room (OR) and underwent a cruciate incision to drain a bulging vaginal septum of copious amounts of yellowish, mucoid fluid. The patient was relieved of her pain, and the left hydrometrocolpos resolved on follow up ultrasounds. However, the patient complained of copious vaginal discharge occurring subsequent to the surgery. The patient underwent a vaginogram, intravenous urogram, and voiding cystourethrogram, which ruled out a vesicovaginal or urethrovaginal fistula. The patient then had menarche at age 11 years and 9 months. She had normal periods occurring every 31–33 days and lasting 7 days. The patient had no complaints of vaginal spotting prior to her menses, however, she did complain of dysmenorrhea lasting 2–5 days. The patient then presented to our division at 12 years and 8 months with continued copious vaginal discharge that was now interfering with her daily activities. A repeat MRI now definitively showed a uterine didelphys with a question of a longitudinal vaginal septum. The patient was taken to the OR and underwent a vaginoscopy, bilateral hysteroscopy and resection of a partially resected vaginal septum. The partially obstructed left hemiuterus was associated with cervical and vaginal adenosis. The bladder was overfilled with diluted indigo carmine dye to further demonstrate the lack of a vesicovaginal fistula. Follow-up at 2 months shows resolution of the symptoms. There have been no reports of vaginal discharge associated with an iatrogenic partially obstructed hemivagina in the world literature. Conclusion: Surgical correction of a unilateral hydrometrocolpos requires delineation of the precise anomaly to determine the appropriate surgical procedure. Accurate diagnosis would have led to a complete resection of the obstructing vaginal septum in this patient at the time of her initial presentation.