Resolution of Hematocolpos in Adolescents Affected with Graft vs Host Disease.

BACKGROUND: Bone marrow transplantation is a lifesaving procedure for a range of serious benign or malignant hematological conditions. A proportion of patients, however, will develop graft vs host disease (GVHD), acute or chronic, with serious long-term sequalae. CASES: We present 2 cases of hematocolpos that developed in adolescence because of vaginal synechiae due to GVHD. The condition was initially asymptomatic, resolved spontaneously at first and recurred. In 1 girl blunt lysis of the adhesions was performed with the patient under general anesthesia, followed thereafter by local hydrocortisone and estriol treatment. SUMMARY AND CONCLUSION: Genital symptoms might not be readily reported by adolescents after bone marrow transplantation. Physicians should be aware of possible late effects of GVHD on genitalia, inquire about symptoms, and be acquainted with addressing complications, such as vaginal obstruction.

Use of Bakri balloon for treatment of persistent hematocolpos after a LeFort Colpocleisis: a case report.

LeFort colpocleisis is a simple and effective procedure for pelvic organ prolapse in women who no longer wish to preserve coital function. If the vaginal channels created during this procedure are not large enough, blood or pus may collect within the uterus or proximal vagina. Hematocolpos, accumulation of blood in apical vagina, may be difficult to manage especially when a patient is frail and has medical comorbidities. Here, we present a case of LeFort colpocleisis in which excessive anticoagulation led to an infected hematocolpos and persistent bleeding. This was successfully managed with a Bakri balloon via a vaginal channel without recurrence of her prolapse.

A novel image-guided balloon vaginoplasty method to treat obstructive vaginal anomalies.

Obstructive anomalies of the vagina that impair uterovaginal outflow and lead to hematocolpos have conventionally been corrected with surgery, but emerging nonsurgical therapies may offer an attractive alternative. The present report describes a method of serial balloon dilation over a transvaginally inserted guide wire to create a durable outflow tract from the uterus to the lower vagina. This technique was successfully used to treat one case each of vaginal atresia and transverse vaginal septum without the immediate need for surgery.

Management of transverse vaginal septum using the Olbert balloon catheter to mobilize the proximal vaginal mucosa and facilitate low anastomosis.

OBJECTIVE: To mobilize and make available for anastomosis the maximal amount of mucosa from the expanded upper vaginal tissue and avoid postoperative narrowing of the vagina. DESIGN: Technique paper. SETTING: Tertiary care medical center. PATIENT(S): Patients with a hematocolpos due to transverse vaginal septum. INTERVENTION(S): Pull through of proximal distended vagina using an Olbert balloon catheter. MAIN OUTCOME MEASURE(S): To avoid midvaginal narrowing due to retraction of the suture line in the surgical management of transverse vaginal septum with hematocolpos. RESULT(S): High-pressure balloon expansion of the proximal hematocolpos optimizes the vaginal mucosa available for final anastomosis. CONCLUSION(S): The use of a high-pressure dilatation balloon permits high intraballoon pressures that facilitate the surgical management of transverse vaginal septum and limit postoperative narrowing of the vagina.

Criptomenorreia / Cryptomenorrhea

Os autores fazem revisao das principais causas de criptomenorreia, e tecem comentarios acerca dos aspectos clinicos, propedeuticos e terapeuticos atuais dessa entidade patologica relativamente rara na pratica ginecologica

Hematometrocolpos / Hematometrocolpos

Apresentam-se dois casos de hematometrocolpos: uma adolescente com massa abdominal e amenorréia primária e uma senhora tratada de uma neoplasia de cérvix por radioterapia e que retornou cerca de 1 ano depois apresentando dor abdominal intensa. Ambos os casos evoluiram satisfatoriamente, apesar de levarem a alguma dificuldade diagnóstica. Chama-se a atençäo para o quadro clínico das pacientes onde prevaleceu a amenorréia, cólicas intermitentes e massa no hipogástrico. O uso da ultra-sonografia é avaliado como arma propedêutica

Complete duplication of the uterus and cervix with a unilaterally imperforate vagina.

Complete duplication of the uterus and cervix with a unilaterally imperforate vagina must be suspected when a unilateral pelvic mass terminates in a purpuric bulge of the lateral vaginal wall in a young woman with severely progressive dysmenorrhea. Intravenous pyelography will reveal renal agenesis ipsilateral to the imperforate vagina. The prompt and accurate diagnosis of this unusual anomaly should lead to transvaginal drainage of the retained menstrual fluids prior to irreversible damage of the pelvic viscera from chronic cryptomenorrhea.

The value of laparoscopy in the management of cystic paravaginal masses.

Gartner's duct cysts and unilateral hematocolpos are unusual conditions presenting as a paravaginal cystic mass. They are frequently mismanaged. Previous authors have cast doubt on the value of laparoscopy and have suggested that primary vaginal drainage is contraindicated. Laparotomy has been performed invariably. In our experience, laparoscopy and primary vaginal drainage has been a safe and successful method of treatment. Three recent cases are reported together with an earlier case.