title: Case of early postoperative adhesion in a patient with molimina due to transverse vaginal septum concomitant with imperforate hymen.
abstract: Transverse vaginal septum is a residual vaginal plate composed of the Müllerian duct and urogenital sinus. Imperforate hymen results from failure of perforation of the membrane between the urogenital sinus and vaginal cavity. We report a rare case of concurrence of these two conditions. A 16-year-old girl had been treated with puncture several times for hematometra and hematocolpos from 13 years of age because of monthly occurrence of lower abdominal pain without menstrual bleeding and was referred to our hospital. Magnetic resonance imaging demonstrated hematometra, hematocolpos and expansion of the vaginal fornix. The imperforate hymen was incised and a slight adhesion at the lower vaginal cavity was detached. After that, a complete transverse vaginal septum, which was 5 mm thick, was identified. It was excised after ultrasonography-guided puncture. Although two cycles of menstrual bleeding took place, molimina recurred. Re-operation was performed 6 months after the first operation, and recurrence of adhesion in the lower vaginal cavity was identified. A silicon dilator was inserted, but she could not use it at home and instead used a tampon. Cyclic menstrual bleeding is observed 4 months after the second operation.
authors.affiliation: Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Koyama-Sato
authors.affiliation: Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Hashida
authors.affiliation: Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan.
authors.forename: Fumiki
authors.initials: F
authors.lastname: Hirahara
authors.affiliation: Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan.
authors.forename: Hideya
authors.initials: H
authors.lastname: Sakakibara
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000517:prevention & control; D000015:Abnormalities, Multiple / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000568:Amenorrhea / Q000209:etiology / Q000517:prevention & control; D000013:Congenital Abnormalities; D004106:Dilatation; D005260:Female; D006399:Hematocolpos / Q000209:etiology / Q000517:prevention & control; D006409:Hematometra / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006924:Hymen / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D007564:Japan; D052576:Menstrual Hygiene Products; D008599:Menstruation Disturbances / Q000503:physiopathology / Q000601:surgery*; D009095:Mullerian Ducts / Q000002:abnormalities / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery; D011677:Punctures / Q000009:adverse effects*; D012008:Recurrence; D012086:Reoperation / Q000009:adverse effects; D000267:Tissue Adhesions / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery; D016896:Treatment Outcome; D014621:Vagina / Q000002:abnormalities / Q000601:surgery*
keywords: imperforate hymen; molimina; primary amenorrhea; transverse vaginal septum; vaginal stenosis