OP16.04: Ultrasound diagnosis of anomalies of uterine cervix and uterus for cervical reconstruction

To diagnose cervical agenesis with functioning uterus in young girls with acute pain abdomen around the age of puberty by ultrasound, and to decide the feasibility and prognosis of utero-cervico-vaginal reconstructive surgery. Patients with acute dysmenorrhoea were evaluated clinically and by ultrasound. Ultrasound was done for presence of hematometra, size of uterus, hydrosalpinx and other associated anomalies. The possibility of reconstructing a functional utero-cervico-vaginal canal was made, and reproductive outcome noted. Fiftyeight (58) patients were diagnosed clinically and on ultrasound to have hematometra of various sizes and position. Complete vaginal and cervical atresia was seen in 54, partial in 2. Hematosalpinx was present in 46, endometrioma in 12, endometriosis in 9. There was fibroma in rudimentary horn in 1 case, single kidney in 9, pelvic kidney in 1, skeletal anomalies in 2, congenital heart defect in 3 girls. Ultrasound diagnosed large hematometra with single / unicornuate / bicornuate / didelphys average sized uterii in 42 cases - in whom laparotomy, abdomino-perineal cervico-vaginoplasty (CVP) in 41 cases, and laparoscopic CVP in 1 case, was performed successfully, with good reproductive outcome. Ultrasound showed large hematometra in 1 horn of uterus didelphys in 4 cases, vaginal cervicoplasty was done in 2 cases, hemi - hysterectomy in 2 cases. In 12 girls with severe dysmenorrhoea, ultrasound showed severe uterine hypoplasia with minimal hematometra. It was decided that CVP would not be useful in these cases with hypoplasia confirmed on laparoscopy / laparotomy, so hysterectomy was performed. Ultrasound was very useful in the workup of girls with severe dysmenorrhoea due to cervical agenesis with functioning uterus, for deciding successful utero-cervico-vaginal reconstruction or performing hysterectomy.