RESUMO
INTRODUCTION AND IMPORTANCE: The isolated complete transverse vaginal septum (TVS) is a rare congenital abnormality. Which can completely obstructed the vagina, can cause a hematometrocolpos associated with cyclic severe pelvic pain and primary amenorrhea. Management of this case was discussed. CASE PRESENTATION: A 14-year-old adelocant girl with primary amenorrhea and severe persistent pelvic pain presented to the gynecology outpatient clinic in our hospital. On pelvic examination, there did not see cervical external os. Radiologic imaging revealed a markedly both fluid intrauterine cavity and upper vaginal canal. The patient underwent general anesthesia, a partial incision of the septum was performed. At discharged time sponge soaked with estrogen cream and 22 number catheter were placed in her vagina to prevent stenosis. CLINICAL DISCUSSION: Transverse vaginal septum is no symptoms until the age of menarche, and can cause recurrent pelvic pain and amenorrhea. The patient underwent general anesthesia, underwent the partial incision of the septum. Then with end-to-end suturing of the remained vaginal edges, and put urinary 22 number catheter inside the upper vagina for preventing stenosis of the vagina in an operating room. CONCLUSION: The excision of septum have put catheter for 3 months with estradiol cream to prevent stenosis and failure of the operation. The management can be performed in the transverse vaginal septum, without any complications. This report gave an option in a simple and effective method that allows the gynecologist to treat this case to reach a good result and still needed to follow up in the future.
RESUMO
INTRODUCTION AND IMPORTANCE: Vulvar penetrating trauma is a rather uncommon occurrence (1). Firearm injuries caused by low-velocity gravitational bullets are a common cause of injuries in war-torn countries such as Somalia [2] (Campbell and Wilbert, 2022). These types of injuries are inflicted on by-standers by wayward bullets. No standard consensus on the appropriate management of vulvar penetrating trauma has been established (3). Here in, we report the successful management of an impacted bullet in the clitoris by a simple incision under local anesthesia. The principles of vulva and clitoris tired bullet trauma management are discussed. In our case, we thought it to be rare and interesting, considering its occurrence. CASE PRESENTATION: In this report, a 24-year-old woman (gravida 2, para 2) suffered from a vulvar area penetrating bullet injury. Imaging revealed that the foreign body was confined to the clitoris, and no evidence of other parts of the body. Under local anesthesia, the bullet was accessed and removed from the clitoris by performing a minor incision. No complications were observed following the surgical removal of the bullet. CLINICAL DISCUSSION: Non-obstetric vulva trauma is an extremely rare occurrence. Typically, the cause of non-obstetric vulvar trauma includes sports-related injuries, straddle injuries, and midline splitting injuries. To the best of our knowledge, this case is unique due to the bullet being retained in the clitoris. The treatment of the foreign body is mostly surgical removal. Under local anesthesia, this patient underwent complete surgical removal of the metallic foreign body. During surgical excision, care should be taken not to damage the urethra and other pelvic issues. CONCLUSION: To the best of our knowledge, this is the first wayward bullet (not intended for the patient) injury penetrating the vulvar area with a retained bullet in the clitoris. In our case, we thought it to be rare and interesting, considering its occurrence.