Resection of a Longitudinal Vaginal Septum in an Obstructed Hemi-Vagina

Abstract

<h3>Study Objective</h3> The objective of this video is to review the diagnosis and management of obstructed hemi-vagina and ipsilateral renal agenesis (OHVIRA) and demonstrate a technique for resection of the longitudinal vaginal septum in a patient with OHVIRA. <h3>Design</h3> Not applicable. <h3>Setting</h3> Patient was placed in lithotomy position. <h3>Patients or Participants</h3> This is the case of a 22-year-old gravida 0 who presented with pelvic pain and vaginal discharge. Her physical exam was notable for a 5 cm fluctuant mass along the right vaginal wall. A pelvic ultrasound and MRI were consistent with Obstructed hemi-vagina and ipsilateral renal agenesis (OHVIRA). OHVIRA is a rare congenital abnormality of the Müllerian ducts, characterized by didelphys uterus, unilateral blind hemi-vagina, and ipsilateral renal agenesis. <h3>Interventions</h3> This video demonstrates a technique for resection of the longitudinal vaginal septum in a patient with OHVIRA. Optimal visualization of the septum was performed using vaginoscopy. A suction bulb was used to prevent outflow from the vagina, which allowed extension of the cavity with normal saline. Additionally, a sidekick needle was inserted through the septum into the obstructed vagina. This step was performed under ultrasound guidance to confirm proper needle placement, allowing distention of the blind hemi-vagina. The vaginal septum was then incised using the bipolar resectoscope. The resection of the septum was completed vaginally using the handheld Ligasure with subsequent visualization of both cervices. <h3>Measurements and Main Results</h3> Not applicable. <h3>Conclusion</h3> Surgical management and drainage of an obstructed hemi-vagina in a patient with OHVIRA is essential for symptom control. Prevention of re-accumulation of the fluid is achieved by complete resection of the septum. This can be facilitated by injecting a distending medium into the obstructed vagina. Trans-abdominal ultrasound can be helpful in confirming proper needle placement during this step, thus preventing vaginal wall damage during resection.