Conservative management of tubo-ovarian abscess as a complication of reconstructive surgery for congenital cervicovaginal agenesis: a case report and review of literature

Conservative management of tubo-ovarian abscess as a complication of reconstructive surgery for congenital cervicovaginal agenesis: a case report and review of literature | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Conservative management of tubo-ovarian abscess as a complication of reconstructive surgery for congenital cervicovaginal agenesis: a case report and review of literature Izat Mohammad Khawajah, Sima Shamshiri Khamene, Zahra Rezaei, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6682515/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Cervical agenesis, a rare birth defect affecting the female reproductive system, is often accompanied by vaginal agenesis in only 39% of cases. In the past, the standard treatment for this condition was hysterectomy. However, as medical technology and techniques continue to advance, more conservative surgeries and assisted reproductive methods are now being considered as the primary treatment options. However, complications such as restenosis, pelvic abscess, and recurrent pelvic endometriosis should always be considered. Case presentation : We report a case of cervicovaginal agenesis complication after reconstructive surgery in a 16-year-old adolescent girl. Conclusion : A conservative surgical approach to cervical malformations may cause complications that can be prevented or managed by regular follow-ups. Tubo-ovarian abscess congenital cervicovaginal agenesis reconstructive surgery Figures Figure 1 Figure 2 Background The prevalence of congenital uterine anomalies vary from 1–10% ( 1 ), Congenital cervical agenesis or dysgenesis is rare, with a prevalence ranging from 1 in 80,000 to 1 in 100,000. ( 2 ) Conservative surgery can lead to serious complications such as endometritis, pelvic inflammatory disease, persistent pelvic pain, bowel or bladder injury, repeat surgery, and death. ( 3 ) Consequently, many experts advocate hysterectomy as the treatment of choice for these patients due to the risk of reoperation or the serious complications described above, as well as the potential for death from reconstructive surgery. ( 4 ) Demolitive treatment is generally reserved for patients with repeated failures of conservative therapy or postoperative complications (such as infections or cervical restenosis) ( 5 ) This case report discusses the conservative management of complications following reconstructive surgery in congenital agenesis of the cervix and vagina, along with a review of articles related to conservative surgical restoration of the reproductive tract in women with congenital cervical agenesis. Case Presentation A 16-year-old adolescent girl presented with persistent fever (up to 40 °C) with abdominopelvic pain, anorexia, and nausea. Laboratory data showed a white blood cell (WBC) count of 15.7×10 3 /µL, 86%neutrophil count, a hemoglobin level of 10.5 g/dL, a platelet count of 285×10 3 /µL and a C-reactive protein (CRP) level of approximately 15.2 mg/dL. The fever persisted despite the antibiotic treatment, which lasted for two weeks. Blood cultures performed on the day of referral were negative. She was a known case of cervicovaginal agenesis. She had undergone laparoscopic uterovaginal anastomosis with the placement of a polytetrafluoroethylene stent for the reconstruction of cervical agenesis and concomitant modified McIndoe vaginoplasty at the age of 11 years. One cm rectal injury occurred during vaginoplasty and was repaired primarily. Her menstruation was regular after surgery. She was under scheduled medical follow-up. Trans-abdominal ultrasound showed a pelvic thick-walled multilocular complicated cyst containing echogenic debris, measuring 70*6.8*56 cm in the left adnexa. Magnetic resonance image revealed a unilateral complex multilocular thick-walled fluid-filled ovarian mass with an irregular thick uniform enhancing wall and septa at the left side of the pelvic, causing pressure on the adjacent uterus associated with surrounding pelvic fat haziness. The above-mentioned lesion in MRI demonstrated heterogeneous intermediate and hyper signal intensity on T2-weighted images, low signal intensity on T1-weighted images, high signal intensity on diffusion-weighted imaging (DWI), and low signal intensity on apparent diffusion coefficient (ADC) indicated restricted diffusion. These observations indicated the presence of tubo-ovarian abscess (Fig. 1) . Additionally, a high T2 signal intensity track with enhancement was seen between the left anterior wall of the lower rectum and the left posterior wall of the vagina with surrounding fat haziness, in favor of the rectovaginal fistula (Fig. 2) . Due to persistent fever, abscess drainage was performed under an ultrasound guide. Puncturing of the swollen left ovary revealed internal pus and pus was collected for bacterial culture and the abscess was excised without any substantial compromise to the ovary. The culture was positive for Escherichia coli . Clindamycin 900 mg IV every 12 hours and Gentamicin loading dose IV (2 mg/kg) followed by 1.5 mg/kg every 8 hours was administered. The rectovaginal fistula was managed conservatively according to the colorectal surgeon's recommendation. She was discharged after 6 days; the CRP level on the day of discharge was 4.12 mg/dL. Oral Clindamycin at 900 mg/BID was continued for 14 days. Finally, imaging performed one month after the procedure showed no recurrence of ovarian abscess. Written informed consent was obtained from the patient and her mother for the publication of the report. Discussion and Conclusion Managing cervical abnormalities, whether with or without a normal vagina, can be both challenging and rewarding. It demands creativity in devising management approaches. Patient participation in the decision-making process is critical, as interventions ultimately affect her life and are associated with irreversible loss or negative impact on reproductive function. (3) Hysterectomy was traditionally primarily the treatment of cervical agenesis to avoid serious complications following reconstructive surgery. (4) Various techniques have been reported in the literature describing procedures creation of a neocervix and a neovagina if needed, and restoration of the continuity of the genital tract. The choice of neovagina and neocervix method and technique of neocervix and neovagina anastomosis is important. (2) Dornelas, reported eleven patients with vaginal agenesis underwent Utero-neovagina anastomosis using a Silicon mold covered by oxidized cellulose. One major postoperative complication occurred, which culminated in death. (6) In a survey done by Rock et al. cervical reconstruction was performed in 11 patients, 6 eventually experienced hysterectomy after obstruction of the neocervical canal. Two cases with cervical agenesis underwent uterovaginal anastomosis. Both required hysterectomy because of pelvic infection due to re-obstruction. (4) A variety of treatment options are available for pelvic inflammatory disease (PID), including conservative management with IV antibiotics, laparoscopic aspiration, image-guided aspiration or drainage, laparoscopic salpingostomy with saline irrigation, and salpingectomy. (7) Rupture of the abscess can be fatal as high as 5%–10% of cases even with advanced treatment and surgical intervention. (8) Immediate and aggressive treatment can lead to a favorable outcome. When OA is suspected, quick treatment is required to prevent adverse outcomes. (9) The treatment recommended for managing infectious complications after reconstructive surgery is hysterectomy. (10) Further, in another case series, 14 patients underwent laparoscopic-assisted uterovaginal anastomosis, nine of whom also underwent concomitant vaginoplasty. Among them, only one patient required a hysterectomy due to restenosis and infection. (11) Kimble R et al. reported two patients with the combined congenital anomalies of complete vaginal agenesis and partial cervical agenesis presented difficulties encountered with the limitations of MRI in the accuracy of diagnosis and clinical correlation of imaging was not easy, as well as the development of life-threatening sepsis requiring hysterectomy and limited counseling by not being able to make an accurate diagnosis. Both patients were at first imaged as having enlarged endometrial cavities and cervical canals with what was thought to be an obstructive upper vaginal septum and an absent lower vagina. Both required initial neovagina creation, however, the cervixes were never clinically or surgically visualized. (5) Three cases in the literature discussed sepsis-related deaths and obstruction secondary to cervical agenesis. Initially, these patients were thought to have a high transverse vaginal septum and were treated by creating a neovagina and establishing communication with the uterine cavity. (12), (13) Despite initially having normal periods, all patients later presented to hospitals with severe infections and obstruction requiring hysterectomy due to infectious morbidity. In one case, the patient continued to decline, developing multi-system organ failure, and ultimately died after a hysterectomy. (12) In all five cases, including the above cases, there was a delay in the accurate definite diagnosis of the abnormality resulting in non-definitive initial treatment. Unfortunately, it was this delay that allowed the development of complications that led to significant morbidity and mortality. Tareq Maraqa et al. reported conservative management of bilateral recurrent pyosalpinx in a 12-year-old girl secondary to retrograde menstruation caused by obstructed hemivagina due to Mullerian duct anomaly. In addition to irrigation and drainage of the abdomen and pelvis, IV and oral antibiotics were sufficient to achieve complete resolution without the need for a salpingostomy or salpingectomy. (14) Tsuyoshi Murata et al. presented a case of ovarian abscess in a virginal adolescent girl without any mullerian anomaly who was treated by laparoscopically abscess drainage. In OA early diagnosis and treatment can remarkably decrease the risk of sepsis, torsion, and adverse effects. (15) The conservative surgical treatment of cervical malformations is a promising option that can be provided with the primary purpose of preserving the uterus for future fertility. Complications following these procedures can also be managed conservatively. However, after the initial surgery, patients should be ready for a lengthy period of follow-up care. Declarations Consent to publish declaration The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's parent has consented to report images and other clinical information in the journal. The patient's parent understands that the names and initials will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed. Data availability statement All data generated or analyzed during this study are included in this published article. Funding None. Conflicts of interest There are no conflicts of interest. Authors' contributions I.K. and S.K. participated in the original drafting and revising of the manuscript. Z.R. and F.A., and K.A. provided the data used in the manuscript. K.A. also supervised and revised the manuscript. Acknowledgments None. References Saravelos SH, Cocksedge KA, Li TC. Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update. 2008;14(5):415–29. Mikos T, Gordts S, Grimbizis GF. Current knowledge about the management of congenital cervical malformations: a literature review. Fertil Steril. 2020;113(4):723–32. Ludwin A, Pfeifer SM. Reproductive surgery for müllerian anomalies: a review of progress in the last decade. Fertil Steril. 2019;112(3):408–16. Rock JA, Roberts CP, Jones Jr HW. Congenital anomalies of the uterine cervix: lessons from 30 cases managed clinically by a common protocol. Fertil Steril. 2010;94(5):1858–63. Kimble R, Molloy G, Sutton B. Partial cervical agenesis and complete vaginal atresia. J Pediatr Adolesc Gynecol. 2016;29(3):e43–7. Dornelas J, Jármy-Di Bella ZIK, Heinke T, Kajikawa MM, Takano CC, Zucchi EVM, et al. Vaginoplasty with oxidized cellulose: anatomical, functional and histological evaluation. Eur J Obstet Gynecol Reprod Biol. 2012;163(2):204–9. Agbor VN, Njim T, Aminde LN. Pyosalpinx causing acute appendicitis in a 32-year-old Cameroonian female: a case report. BMC Res Notes. 2016;9:1–4. Cho HW, Koo YJ, Min KJ, Hong JH, Lee JK. Pelvic inflammatory disease in virgin women with tubo-ovarian abscess: a single-center experience and literature review. J Pediatr Adolesc Gynecol. 2017;30(2):203–8. Hakim J, Childress KJ, Hernandez AM, Bercaw-Pratt JL. Tubo-ovarian abscesses in nonsexually active adolescent females: a large case series. J Adolesc Heal. 2019;65(2):303–5. Mikos T, Lantzanaki M, Anthoulakis C, Grimbizis GF. Functional and reproductive outcomes following surgical management of congenital anomalies of the cervix: a systematic review. J Minim Invasive Gynecol. 2021;28(8):1452–61. Kriplani A, Kachhawa G, Awasthi D, Kulshrestha V. Laparoscopic-assisted uterovaginal anastomosis in congenital atresia of uterine cervix: follow-up study. J Minim Invasive Gynecol. 2012;19(4):477–84. Casey AC, Laufer MR. Cervical agenesis: septic death after surgery. Obstet Gynecol. 1997;90(4 Part 2):706–7. Rock JT clinical management of congenital absence of the uterine cervixA, Schlaff WD, Zacur HA, Jones Jr HW. The clinical management of congenital absence of the uterine cervix. Int J Gynecol Obstet. 1984;22(3):231–5. Maraqa T, Mohamed M, Coffey D, Sachwani-Daswani GR, Alvarez C, Mercer L. Bilateral recurrent pyosalpinx in a sexually inactive 12-year-old girl secondary to rare variant of Mullerian duct anomaly. Case Reports. 2017;2017:bcr-2016. Murata T, Endo Y, Furukawa S, Ono A, Kiko Y, Soeda S, et al. Successful laparoscopic resection of ovarian abscess caused by Staphylococcus aureus in a 13-year-old girl: a case report and review of literature. BMC Womens Health. 2021;21(1):198. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6682515","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":471884875,"identity":"5b8bff7f-f502-4e99-9acf-0d6c5dcf838f","order_by":0,"name":"Izat Mohammad Khawajah","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Izat","middleName":"Mohammad","lastName":"Khawajah","suffix":""},{"id":471884876,"identity":"d065cd6a-444c-418d-b4df-c4a9694fc18f","order_by":1,"name":"Sima Shamshiri Khamene","email":"","orcid":"","institution":"Tehran University of Medical 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Adabi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYBACCQkgZmyQkONnbwByDSyI12Is2XMApEWCaC0MiRtuJID5hLVIzm5+eOPnDgtjyZnPr274USDBwN/enYBXi7TMMWPL3jNAv0jnlN3sATpM4szZDXi1yEkkmEnwtgH9Mjsn7QYPUIuBRC4hLenfJP+2SSRuuHkm7eYfYrRIS+SYSfOCtNxgP3abKFskZ+QUW8ueAQVyDtttGQMJHoJ+kbiRvvHm2x11wKg8/uzmmz82cvztvfi1IAEeAzBJrHIQYH9AiupRMApGwSgYQQAAax9GjaaAO8QAAAAASUVORK5CYII=","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Khadijeh","middleName":"","lastName":"Adabi","suffix":""}],"badges":[],"createdAt":"2025-05-16 16:53:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6682515/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6682515/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85345209,"identity":"44e8641e-500c-406c-ab08-527c115b09b4","added_by":"auto","created_at":"2025-06-25 01:58:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":944821,"visible":true,"origin":"","legend":"\u003cp\u003eA complex multilocular thick-walled cystic ovarian mass with heterogenous high T2 signal \u003cstrong\u003e(A)\u003c/strong\u003e and irregular thick uniform enhancing wall and septa in post contrast T1 images \u003cstrong\u003e(B)\u003c/strong\u003e at left adnexa is noted with restricted diffusion in DWI sequence (not shown), causing pressure on the adjacent uterus associated with surrounding pelvic fat haziness suggestive for Tubo-Ovarian Abscess (TOA).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6682515/v1/481f2252e4b1428438a3828f.png"},{"id":85345207,"identity":"5dba8138-2a52-4071-be78-e5658460fe68","added_by":"auto","created_at":"2025-06-25 01:58:15","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":741150,"visible":true,"origin":"","legend":"\u003cp\u003eA high T2 signal intensity track \u003cstrong\u003e(A)\u003c/strong\u003e is seen between the left anterior wall of the lower rectum and the left posterior wall of the vagina with surrounding fat haziness and increase enhancement in post-contrast T1 images \u003cstrong\u003e(B)\u003c/strong\u003e, in favor of the rectovaginal fistula.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6682515/v1/08ed346cc5c2db6ca4a3d5f0.png"},{"id":95312507,"identity":"526b685b-b013-4564-942a-cec1bd0f0746","added_by":"auto","created_at":"2025-11-06 15:49:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2498975,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6682515/v1/c4799d0f-42f4-4228-a78d-b195dd149133.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Conservative management of tubo-ovarian abscess as a complication of reconstructive surgery for congenital cervicovaginal agenesis: a case report and review of literature","fulltext":[{"header":"Background","content":"\u003cp\u003eThe prevalence of congenital uterine anomalies vary from 1\u0026ndash;10% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), Congenital cervical agenesis or dysgenesis is rare, with a prevalence ranging from 1 in 80,000 to 1 in 100,000. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eConservative surgery can lead to serious complications such as endometritis, pelvic inflammatory disease, persistent pelvic pain, bowel or bladder injury, repeat surgery, and death. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Consequently, many experts advocate hysterectomy as the treatment of choice for these patients due to the risk of reoperation or the serious complications described above, as well as the potential for death from reconstructive surgery. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eDemolitive treatment is generally reserved for patients with repeated failures of conservative therapy or postoperative complications (such as infections or cervical restenosis) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThis case report discusses the conservative management of complications following reconstructive surgery in congenital agenesis of the cervix and vagina, along with a review of articles related to conservative surgical restoration of the reproductive tract in women with congenital cervical agenesis.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 16-year-old adolescent girl presented with persistent fever (up to 40 \u0026deg;C) with abdominopelvic pain, anorexia, and nausea. Laboratory data showed a white blood cell (WBC) count of 15.7\u0026times;10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;L, 86%neutrophil count, a hemoglobin level of 10.5 g/dL, a platelet count of 285\u0026times;10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;L and a C-reactive protein (CRP) level of approximately 15.2 mg/dL. The fever persisted despite the antibiotic treatment, which lasted for two weeks. Blood cultures performed on the day of referral were negative. She was a known case of cervicovaginal agenesis. She had undergone laparoscopic uterovaginal anastomosis with the placement of a polytetrafluoroethylene stent for the reconstruction of cervical agenesis and concomitant modified McIndoe vaginoplasty at the age of 11 years. One cm rectal injury occurred during vaginoplasty and was repaired primarily. Her menstruation was regular after surgery. She was under scheduled medical follow-up.\u003c/p\u003e\n\u003cp\u003eTrans-abdominal ultrasound showed a pelvic thick-walled multilocular complicated cyst containing echogenic debris, measuring 70*6.8*56 cm in the left adnexa. Magnetic resonance image revealed a unilateral complex multilocular thick-walled fluid-filled ovarian mass with an irregular thick uniform enhancing wall and septa at the left side of the pelvic, causing pressure on the adjacent uterus associated with surrounding pelvic fat haziness. The above-mentioned lesion in MRI demonstrated heterogeneous intermediate and hyper signal intensity on T2-weighted images, low signal intensity on T1-weighted images, high signal intensity on diffusion-weighted imaging (DWI), and low signal intensity on apparent diffusion coefficient (ADC) indicated restricted diffusion. These observations indicated the presence of tubo-ovarian abscess \u003cstrong\u003e(Fig. 1)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eAdditionally, a high T2 signal intensity track with enhancement was seen between the left anterior wall of the lower rectum and the left posterior wall of the vagina with surrounding fat haziness, in favor of the rectovaginal fistula \u003cstrong\u003e(Fig. 2)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eDue to persistent fever, abscess drainage was performed under an ultrasound guide. Puncturing of the swollen left ovary revealed internal pus and pus was collected for bacterial culture and the abscess was excised without any substantial compromise to the ovary. The culture was positive for \u003cem\u003eEscherichia coli\u003c/em\u003e. Clindamycin 900 mg IV every 12 hours\u0026nbsp;and\u0026nbsp;Gentamicin loading dose IV (2 mg/kg) followed by 1.5 mg/kg every 8 hours was administered.\u003c/p\u003e\n\u003cp\u003eThe rectovaginal fistula was managed conservatively according to the colorectal surgeon\u0026apos;s recommendation. She was discharged after 6 days; the CRP level on the day of discharge was 4.12 mg/dL. Oral\u0026nbsp;Clindamycin\u0026nbsp;at 900 mg/BID\u0026nbsp;was continued for 14 days. Finally, imaging performed one month after the procedure showed no recurrence of ovarian abscess.\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient and her mother for the publication of the report.\u003c/p\u003e"},{"header":"Discussion and Conclusion","content":"\u003cp\u003eManaging cervical abnormalities, whether with or without a normal vagina, can be both challenging and rewarding. It demands creativity in devising management approaches.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatient participation in the decision-making process is critical, as interventions ultimately affect her life and are associated with irreversible loss or negative impact on reproductive function. (3)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHysterectomy was traditionally primarily the treatment of cervical agenesis to avoid serious complications following reconstructive surgery. (4)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVarious techniques have been reported in the literature describing procedures creation of a neocervix and a neovagina if needed, and restoration of the continuity of the genital tract. The choice of neovagina and neocervix method and technique of neocervix and neovagina anastomosis is important. (2)\u0026nbsp;Dornelas, reported eleven patients with vaginal agenesis underwent Utero-neovagina anastomosis using a Silicon mold covered by oxidized cellulose. One major postoperative complication occurred, which culminated in death. (6)\u0026nbsp;In a survey done by Rock et al. cervical reconstruction was performed in 11 patients, 6 eventually experienced hysterectomy after obstruction of the neocervical canal. Two cases with cervical agenesis underwent uterovaginal anastomosis. Both required hysterectomy because of pelvic infection due to re-obstruction.\u0026nbsp;(4)\u003c/p\u003e\n\u003cp\u003eA variety of treatment options are available for pelvic inflammatory disease (PID), including conservative management with IV antibiotics, laparoscopic aspiration, image-guided aspiration or drainage, laparoscopic salpingostomy with saline irrigation, and salpingectomy.\u0026nbsp;(7) Rupture of the abscess can be fatal as high as 5%\u0026ndash;10% of cases even with advanced treatment and surgical intervention. (8) Immediate and aggressive treatment can lead to a favorable outcome.\u003c/p\u003e\n\u003cp\u003eWhen OA is suspected, quick treatment is required to prevent adverse outcomes. (9) The treatment recommended for managing infectious complications after reconstructive surgery is hysterectomy. (10) Further, in another case series, 14 patients underwent laparoscopic-assisted uterovaginal anastomosis, nine of whom also underwent concomitant vaginoplasty. Among them, only one patient required a hysterectomy due to restenosis and infection. (11)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKimble R et al. reported two patients with the combined congenital anomalies of complete vaginal agenesis and partial cervical agenesis presented difficulties encountered with the limitations of MRI in the accuracy of diagnosis and clinical correlation of imaging was not easy, as well as the development of life-threatening sepsis requiring hysterectomy and limited counseling by not being able to make an accurate diagnosis. Both patients were at first imaged as having enlarged endometrial cavities and cervical canals with what was thought to be an obstructive upper vaginal septum and an absent lower vagina. Both required initial neovagina creation, however, the cervixes were never clinically or surgically visualized. (5)\u003c/p\u003e\n\u003cp\u003eThree cases in the literature discussed sepsis-related deaths and obstruction secondary to cervical agenesis. Initially, these patients were thought to have a high transverse vaginal septum and were treated by creating a neovagina and establishing communication with the uterine cavity. (12), (13) Despite initially having normal periods, all patients later presented to hospitals with severe infections and obstruction requiring hysterectomy due to infectious morbidity. In one case, the patient continued to decline, developing multi-system organ failure, and ultimately died after a hysterectomy. (12) In all five cases, including the above cases, there was a delay in the accurate definite diagnosis of the abnormality resulting in non-definitive initial treatment. Unfortunately, it was this delay that allowed the development of complications that led to significant morbidity and mortality.\u003c/p\u003e\n\u003cp\u003eTareq Maraqa et al. reported conservative management of bilateral recurrent pyosalpinx in a 12-year-old girl secondary to retrograde menstruation caused by obstructed hemivagina due to Mullerian duct anomaly. In addition to irrigation and drainage of the abdomen and pelvis, IV and oral antibiotics were sufficient to achieve complete resolution without the need for a salpingostomy or salpingectomy. (14)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTsuyoshi Murata et al. presented a case of ovarian abscess in a virginal adolescent girl without any mullerian anomaly who was treated by laparoscopically abscess drainage. In OA early diagnosis and treatment can remarkably decrease the risk of sepsis, torsion, and adverse effects. (15)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe conservative surgical treatment of cervical malformations is a promising option that can be provided with the primary purpose of preserving the uterus for future fertility. Complications following these procedures can also be managed conservatively. However, after the initial surgery, patients should be ready for a lengthy period of follow-up care.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent to publish declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors certify that they have obtained all appropriate patient consent forms. In the form, the patient\u0026apos;s parent has consented to report images and other clinical information in the journal. The patient\u0026apos;s parent understands that the names and initials will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI.K. and S.K. participated in the original drafting and revising of the manuscript. Z.R. and F.A., and K.A. provided the data used in the manuscript. K.A. also supervised and revised the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSaravelos SH, Cocksedge KA, Li TC. Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update. 2008;14(5):415\u0026ndash;29. \u003c/li\u003e\n\u003cli\u003eMikos T, Gordts S, Grimbizis GF. Current knowledge about the management of congenital cervical malformations: a literature review. Fertil Steril. 2020;113(4):723\u0026ndash;32. \u003c/li\u003e\n\u003cli\u003eLudwin A, Pfeifer SM. Reproductive surgery for m\u0026uuml;llerian anomalies: a review of progress in the last decade. Fertil Steril. 2019;112(3):408\u0026ndash;16. \u003c/li\u003e\n\u003cli\u003eRock JA, Roberts CP, Jones Jr HW. Congenital anomalies of the uterine cervix: lessons from 30 cases managed clinically by a common protocol. Fertil Steril. 2010;94(5):1858\u0026ndash;63. \u003c/li\u003e\n\u003cli\u003eKimble R, Molloy G, Sutton B. Partial cervical agenesis and complete vaginal atresia. J Pediatr Adolesc Gynecol. 2016;29(3):e43\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eDornelas J, J\u0026aacute;rmy-Di Bella ZIK, Heinke T, Kajikawa MM, Takano CC, Zucchi EVM, et al. Vaginoplasty with oxidized cellulose: anatomical, functional and histological evaluation. Eur J Obstet Gynecol Reprod Biol. 2012;163(2):204\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eAgbor VN, Njim T, Aminde LN. Pyosalpinx causing acute appendicitis in a 32-year-old Cameroonian female: a case report. BMC Res Notes. 2016;9:1\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eCho HW, Koo YJ, Min KJ, Hong JH, Lee JK. Pelvic inflammatory disease in virgin women with tubo-ovarian abscess: a single-center experience and literature review. J Pediatr Adolesc Gynecol. 2017;30(2):203\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eHakim J, Childress KJ, Hernandez AM, Bercaw-Pratt JL. Tubo-ovarian abscesses in nonsexually active adolescent females: a large case series. J Adolesc Heal. 2019;65(2):303\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eMikos T, Lantzanaki M, Anthoulakis C, Grimbizis GF. Functional and reproductive outcomes following surgical management of congenital anomalies of the cervix: a systematic review. J Minim Invasive Gynecol. 2021;28(8):1452\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eKriplani A, Kachhawa G, Awasthi D, Kulshrestha V. Laparoscopic-assisted uterovaginal anastomosis in congenital atresia of uterine cervix: follow-up study. J Minim Invasive Gynecol. 2012;19(4):477\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eCasey AC, Laufer MR. Cervical agenesis: septic death after surgery. Obstet Gynecol. 1997;90(4 Part 2):706\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eRock JT clinical management of congenital absence of the uterine cervixA, Schlaff WD, Zacur HA, Jones Jr HW. The clinical management of congenital absence of the uterine cervix. Int J Gynecol Obstet. 1984;22(3):231\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eMaraqa T, Mohamed M, Coffey D, Sachwani-Daswani GR, Alvarez C, Mercer L. Bilateral recurrent pyosalpinx in a sexually inactive 12-year-old girl secondary to rare variant of Mullerian duct anomaly. Case Reports. 2017;2017:bcr-2016. \u003c/li\u003e\n\u003cli\u003eMurata T, Endo Y, Furukawa S, Ono A, Kiko Y, Soeda S, et al. Successful laparoscopic resection of ovarian abscess caused by Staphylococcus aureus in a 13-year-old girl: a case report and review of literature. BMC Womens Health. 2021;21(1):198. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Tubo-ovarian abscess, congenital cervicovaginal agenesis, reconstructive surgery","lastPublishedDoi":"10.21203/rs.3.rs-6682515/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6682515/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eCervical agenesis, a rare birth defect affecting the female reproductive system, is often accompanied by vaginal agenesis in only 39% of cases. In the past, the standard treatment for this condition was hysterectomy. However, as medical technology and techniques continue to advance, more conservative surgeries and assisted reproductive methods are now being considered as the primary treatment options. However, complications such as restenosis, pelvic abscess, and recurrent pelvic endometriosis should always be considered.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e: We report a case of cervicovaginal agenesis complication after reconstructive surgery in a 16-year-old adolescent girl.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: A conservative surgical approach to cervical malformations may cause complications that can be prevented or managed by regular follow-ups.\u003c/p\u003e","manuscriptTitle":"Conservative management of tubo-ovarian abscess as a complication of reconstructive surgery for congenital cervicovaginal agenesis: a case report and review of literature","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-25 01:58:11","doi":"10.21203/rs.3.rs-6682515/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"23f6f360-a351-4ff8-a78c-862f35d659f2","owner":[],"postedDate":"June 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-04T00:23:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-25 01:58:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6682515","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6682515","identity":"rs-6682515","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}