Novel use of a stent in a patient with cervical agenesis, partial vaginal agenesis and uterine didelphys. case report

Abstract

Novel use of a stent to maintain patency after cervical reconstruction in cervical and vaginal agenesis and uterine didelphys. Case report. 19 year-old woman with primary amenorrhea due to a dydelphys uterus with total cervical and upper third vaginal agenesis. Pelvic ultrasound showed the right and left hemi-uteri completely separated and almost in contact with pelvic wall. Cervix and upper third of the vagina could not be identified. MNR revealed similar images than the sonogram. Laparoscopy demonstrated an accurate assessment of the Mullerian defect, only a cervical stump could be seen. Strassman operation was performed to correct dydelphys uterus; a new cervix was reconstructed using both cervical stumps, followed by a uterine-vaginal anastomosis. A Foley catheter was placed to keep the new cervical channel open. Patient referred a normal menstruation ten days later, first time in her life. Foley catheter was removed six weeks after surgery, follow by weekly cervical dilatations, but 8 weeks later cervical canal was definitely closed. A special stent was developed to be placed in a new cervical channel. A small incision was performed in the uterine fundus by a laparotomy to place the stent in the cervical area. A cervical lumen was drilled and then the stent was placed immediately. 15 days later patient resume her menstrual cycle. Three and a half years later the patient is still menstruating. At speculum examination it could be seen distal portion of the stent and fluid mucus filling the new cervical canal. Cervical agenesis treatment is disappointing and therefore discouraged. Cervical agenesis usually finishes with hysterectomy or serious infection as a result of treatment failure. Cervical stent is a good option to offer to these patients to recover their women status, they keep their uterus and menstruation, carry on an positive psychological impact, and the hope of future fertility, that otherwise to date was completely lost.