title: Nearly Normal Congenital Cervical Fragmentation: A Hard-To-Diagnose and Successful End-To-End Anastomosis.
abstract: BACKGROUND
  Congenital cervical fragmentation is a very rare genital tract malformation that usually presents in adolescence with primary amenorrhea and cyclic, monthly, lower abdominal pain. We report a nearly normal case of congenital cervical fragmentation and successful end-to-end anastomosis.
  
  
  METHODS
  A 15-year-old girl presented with primary amenorrhea with cyclic, monthly lower abdominal pain lasting for 15 months without any abnormal imaging findings (pelvic CT scan, ultrasonography, and hysteroscopy). Misdiagnosis and appendectomy was performed at the time of the initial lower abdominal pain. Diagnostic combined hysteroscopy and laparoscopy were performed in our hospital, and cervical fragmentation was diagnosed. A converted laparotomy end-to-end anastomosis was performed successfully, and regular menstruation was restored after the operation.
  
  
  CONCLUSIONS
  The malformation of nearly normal congenital cervical fragmentation is existent and hard to diagnose. As long as the patient has persistent primary amenorrhea with cyclic, monthly lower abdominal pain, even if no abnormal findings on imaging, obstructive malformation of the reproductive duct should be the primary suspicion. Diagnosis and treatment should occur as early as possible to preserve the patient's fertility. End-to-end anastomosis is the best method for this type of patient.
authors.affiliation: Department of Gynecology, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Department of Gynecology, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Gynecology, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China.
authors.forename: Yuan-Zhe
authors.initials: YZ
authors.lastname: Wu
authors.affiliation: Department of Gynecology, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China.
authors.forename: Qiu-Ming
authors.initials: QM
authors.lastname: Zhou
authors.affiliation: Department of Gynecology, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China.
authors.forename: Qun
authors.initials: Q
authors.lastname: Guan
authors.affiliation: Department of Gynecology, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China.
authors.forename: Lin-Dong
authors.initials: LD
authors.lastname: Yang
authors.affiliation: Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China. Electronic address: shiqunli2005@aliyun.com.
authors.forename: Qun-Li
authors.initials: QL
authors.lastname: Shi
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000568:Amenorrhea / Q000209:etiology / Q000628:therapy; D002584:Cervix Uteri / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D010535:Laparoscopy; D008598:Menstruation; D011247:Pregnancy
keywords: Anastomosis; Congenital cervical fragmentation; Mullerian duct anomalies