A Preliminary Approach to the Traditional Method in High Transverse Vaginal Septum

Zahra Raoofi, Nahid Mostaghel
In: Journal of Pelvic Medicine and Surgery · 2009 · vol. 15(4) , pp. 217–219 · doi:10.1097/spv.0b013e3181b204bb · W1980590126
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Laparoscopic evacuation of hematocolpos and hemoperitoneum in a patient with high transverse vaginal septum improved compliance for subsequent surgery and may reduce endometriosis incidence by removing pelvic blood.

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This study describes a preliminary surgical strategy for managing high transverse vaginal septum in pubertal patients, focusing on laparoscopic evacuation of hematocolpos and hemoperitoneum to alleviate acute pain. The protocol additionally incorporates oral contraceptive therapy for endometrial suppression and psychological preparation to improve patient compliance with subsequent vaginal dilatation procedures. Results indicate that this staged approach is well-tolerated and facilitates better adherence to postoperative care after the definitive septum resection one year later. The authors note that removing accumulated blood from the pelvis may reduce the incidence of secondary endometriosis. This paper is centrally about endometriosis — specifically as a potential complication mitigated by early intervention in cases of obstructive Müllerian anomalies like transverse vaginal septum.

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Abstract

In Brief Introduction: Transverse vaginal septum diagnosed after the onset of puberty presents numerous problems such as difficult anastomosis and poor compliance with postoperative dilatation. A preliminary approach can be laparoscopic evacuation of hematocolpos and hemoperitoneum. Materials/Methods: A preliminary approach to the traditional method is described for a patient with a high transverse vaginal septum presenting at puberty. This includes laparoscopic evacuation of hematocolpos and hemoperitonium to relieve pain, endometrial suppression with oral contraceptive pills to prevent recurrent hematocolpos, and motivation and preparation of the patient for pre- and postoperative vaginal dilatation. Result: This approach is well tolerated by the patient. After 1 year, the patient underwent resection of the septum and had an acceptable compliance with postoperative vaginal dilatation. Conclusion: This preliminary approach can prepare and motivate the patient and may decrease the incidence of endometriosis because of complete removal of blood from the pelvis and abdomen. Transverse vaginal septum diagnosed after the onset of puberty presents numerous problems such as difficult anastomosis and poor compliance with postoperative dilatation. A preliminary approach can be laparoscopic evacuation of hematocolpos and hemoperitoneum, which can prepare and motivate the patient and may decrease the incidence of endometriosis.
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Introduction

Transverse vaginal septum diagnosed after the onset of puberty presents numerous problems such as difficult anastomosis and poor compliance with postoperative dilatation. A preliminary approach can be laparoscopic evacuation of hematocolpos and hemoperitoneum. Materials/Methods: A preliminary approach to the traditional method is described for a patient with a high transverse vaginal septum presenting at puberty. This includes laparoscopic evacuation of hematocolpos and hemoperitonium to relieve pain, endometrial suppression with oral contraceptive pills to prevent recurrent hematocolpos, and motivation and preparation of the patient for pre- and postoperative vaginal dilatation.

Result

This approach is well tolerated by the patient. After 1 year, the patient underwent resection of the septum and had an acceptable compliance with postoperative vaginal dilatation.

Conclusion

This preliminary approach can prepare and motivate the patient and may decrease the incidence of endometriosis because of complete removal of blood from the pelvis and abdomen.

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endometriosis

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