title: Ultrasound-assisted repair of a unique case of distal vaginal agenesis.
abstract: OBJECTIVE
  To describe a unique vaginal outlet obstruction and its ultrasound-assisted surgical correction.
  
  
  METHODS
  Case report.
  
  
  METHODS
  An academic medical center.
  
  
  METHODS
  A 12-year-old girl was seen with cyclic abdominal pain, nausea, and an abdominal mass. External genital examination revealed no vaginal opening or dimple. Transabdominal ultrasound revealed a large hematometrocolpos 5 cm proximal to the perineum, with an otherwise normal-appearing uterus and ovaries.
  
  
  METHODS
  Surgical treatment included perineal incision, creation of a 5-cm passage through connective tissue, drainage of the hematometrocolpos, and mobilization of the proximal vagina, allowing for pull-through vaginoplasty. Ultrasound guidance was used throughout the surgery and allowed for a safe transperineal approach. A vaginal form was placed in the neovagina.
  
  
  METHODS
  Follow-up clinical evaluation and pelvic ultrasonography.
  
  
  RESULTS
  A well-healed perineum and patent 5-cm-long vagina were observed at 4-month follow-up. The patient reported three regular menses. Postoperative pelvic ultrasound scan was normal.
  
  
  CONCLUSIONS
  We describe a unique case of isolated distal vaginal agenesis of significant length that was successfully treated via a perineal approach with the intra-operative assistance of ultrasound guidance.
authors.affiliation: The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kresowik
authors.forename: Ginny L
authors.initials: GL
authors.lastname: Ryan
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Austin
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Van Voorhis
mesh_terms: D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D014463:Ultrasonography; D014621:Vagina / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery