title: Rare Müllerian Anomaly: Complete Septate Uterus with Simultaneous Longitudinal and Transverse Vaginal Septa.
abstract: BACKGROUND
  We present a patient with primary amenorrhea and a rare combination of anomalies. She was found to have a septate uterus, double cervix, and a longitudinal and a low transverse vaginal septum.
  
  
  METHODS
  An 18-year-old girl with primary amenorrhea presented with severe monthly pelvic pain. Examination and imaging revealed a thin transverse vaginal septum, complete septate uterus, double cervix, and a longitudinal vaginal septum. The transverse and longitudinal vaginal septa were excised and repaired.
  
  
  CONCLUSIONS
  Although repetitive pregnancy loss and preterm birth are associated with various Müllerian duct anomalies, clinicians should also be suspicious of the presented anomaly in cases of primary amenorrhea and cyclic pelvic pain. To our knowledge, this is the only case of simultaneous septate uterus with longitudinal and transverse vaginal septum and the second case of combined longitudinal and transverse septum, which caused primary amenorrhea. This rare anomaly further supports the bidirectional regression theory of Müllerian development.
authors.affiliation: Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan. Electronic address: elouden@med.wayne.edu.
authors.forename: Erica D
authors.initials: ED
authors.lastname: Louden
authors.affiliation: Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan.
authors.forename: Awoniyi O
authors.initials: AO
authors.lastname: Awonuga
authors.affiliation: Gago Center for Fertility, Brighton, Michigan.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Gago
authors.affiliation: Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan.
authors.forename: Manvinder
authors.initials: M
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000568:Amenorrhea / Q000209:etiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009095:Mullerian Ducts / Q000002:abnormalities* / Q000601:surgery; D017699:Pelvic Pain / Q000209:etiology; D011247:Pregnancy; D014564:Urogenital Abnormalities / Q000175:diagnosis* / Q000601:surgery; D014599:Uterus / Q000002:abnormalities* / Q000601:surgery; D014621:Vagina / Q000002:abnormalities* / Q000601:surgery
keywords: Mullerian anomalies; Pelvic pain; Pimary amenorrhea; Septate uterus; Vaginal septum