title: Management of lower vaginal agenesis in a patient with unicornuate uterus.
abstract: BACKGROUND
  Absence of the lower vagina occurs from abnormal development of the sinovaginal bulbs and vaginal plate.
  
  
  METHODS
  We present a case of an adolescent girl, with a history of VACTERL and VATER status post flap vaginoplasty at 8 m of age and correction of vaginal-urethral fistula, with primary amenorrhea and cyclic pelvic pain. MRI showed a right hematocolpos. On exam the obstructed vagina was deviated to the right. Given prior urologic and rectal surgery, and laterality of unicornuate system, intra-operative ultrasonography (US) was performed. A needle was used to enter the inferior aspect of the obstructed vagina. A pull-through vaginoplasty was performed.
  
  
  CONCLUSIONS
  Vaginal pull-through is the standard treatment for lower vaginal agenesis. In a unicornuate system, the use of intra-operative US is helpful to determine the appropriate angle of dissection.
authors: Division of Gynecology, Children's Hospital, Boston, MA 02115, USA.
authors: Rebecca H
authors: RH
authors: Jessel
authors: Marc R
authors: MR
authors: Laufer
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000002:abnormalities / Q000601:surgery; D004947:Esophagus / Q000002:abnormalities / Q000601:surgery; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery; D006399:Hematocolpos / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007668:Kidney / Q000002:abnormalities / Q000601:surgery; D017880:Limb Deformities, Congenital / Q000150:complications* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D013131:Spine / Q000002:abnormalities / Q000601:surgery; D014132:Trachea / Q000002:abnormalities / Q000601:surgery; D014599:Uterus / Q000002:abnormalities* / Q000601:surgery; D014621:Vagina / Q000002:abnormalities* / Q000601:surgery; D014623:Vaginal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery