Management of a transverse vaginal septum complicated with hematocolpos in an adolescent girl: Case report

INTRODUCTION: The transverse septum of the vagina or vaginal septum is a rare abnormality of the female genital tract. The most frequently advanced etiology is a defect in the fusion and/or channelling of the urogenital sinus and Mullerian conductors. This structural obstruction can completely obstruct the vagina and thus can cause a haematocolpos associated with cyclic pelvic pain shortly after menarche in adolescent girls. The diagnosis of a vaginal septum is based on a careful clinical gynaecological examination and especially on ultrasound scan via the abdominal or transrectal (see Transperineal) and in more complex cases on MRI. The treatment is surgical and must be carried out as early as possible. CASE REPORT: We report the management of a case of a 16 year old girl who presented a haematocolpos complicating a complete transverse vaginal septum. The treatment consisted of making a transverse incision in the centre of the transverse septum of the vagina, draining the hematocolpos and visualising the cervix. A circumferential excision of the septum was made and the remaining vaginal edges were then sutured by a simple tarring of the entire circumference with Vicryl 2.0. A sponge soaked in oestrogen cream was placed in her vagina to prevent stenosis and removed the day after the operation. The patient was followed in our department for 2 years without any recurrence of vaginal stenosis or hematocolpos. CONCLUSION: The transverse vaginal septum remains a rare anomaly of the female genital tract, the reasons for its discovery are extremely variable according to its shape and location. Haematocolpos remains the main consequence of these septums. The management is essentially based on surgery while taking into account the risks of postoperative stenosis and the repercussions on the upper genital tract.