We report this case as an unusual presentation of primary amenorrhea with hematometra likely because of cervical agenesis. On review of the literature, cervical agenesis or aplasia is a rare congenital variation of Müllerian anomalies and commonly associated with partial or complete vaginal atresia, agenesis, or septum 7. These patients usually present after puberty with cyclic abdominal pain with different-size pelviabdominal masses depending on the time of presentation after puberty. US is a less reliable imaging tool, but still remains the first method for diagnosis. However, MRI is known to be the best method for diagnosis in these cases; still, it is difficult to differentiate between complete agenesis and dysgenesis of the cervix, and the diagnosis needs to be confirmed intraoperatively 8. In our patient, the MRI (Fig. 2), with her clinical history of trauma with documented different pelvic organ injuries at the age of 3 years with bleeding per vagina for a period of time, and considering that only conservative management had been followed, misdiagnosis of uterine transection was expected. This diagnosis was supported by our intraoperative findings of adhesions between the base of the bladder and the cervicouterine area and cervix, and also normal cervical length and patent canal with a normal uterus and other pelvic organs.
Although different surgical techniques are reported for the management of cervical agenesis, the method of choice remains controversial 9. Hysterectomy was the management for these cases before because of the complication of cervical recanalization and the difficulty of having normal viable pregnancy 10. Improved surgical techniques and preservation of the uterus for future fertility are considered to be the first line of treatment at present 11. In this case, we report a traumatic cervicouterine transection that was repaired with anastomosis of the transected part over the Foley’s catheter, which kept in as a stent to promote epithelization of the cervicouterine junction and prevent stenosis or obstruction. Follow-up of these patients is recommended as restenosis or obstruction can occur again as reported by others 10–12.
Cervical agenesis isolated or with different degrees of vaginal aplasia is rare and always reported as the congenital cause of primary amenorrhea and hematometra in adolescent patients. In our patient, traumatic misdiagnosed uterocervical transection during her childhood was the diagnosis on the basis of her history and intraoperative findings. To our knowledge, this is the first reported case of cervicouterine obstruction because of traumatic cervicouterine transaction injury.
There are no conflicts of interest.
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