cervical aplasia is a mullerian anomaly , in which patients lack a uterine cervix and the lower uterine segment narrows to terminate in a peritoneal sleeve at a point well above the normal communication with the vaginal apex . we report a case of cervical aplasia , associated with a functioning uterine corpus and an absent vagina . reporting the case of an 18-year - old unmarried girl , who presented to us with history of primary amenorrhea and cyclical lower abdominal pain . on examination , bimanual rectal examination was normal . her hormonal profile and all the other routine blood tests were normal . examination under anesthesia confirmed absent vagina . on inserting the laparoscope , a big endometriotic cyst in left ovary was visualized . a year later , she again presented to us with pain abdomen and another endometriotic cyst in the left ovary . she was taken up for a re - look laparoscopy in an attempt to create a passage - way for menstruation . we had good experience in this as we had successfully created such a menstrual passage - way in the past in two of our patients with fragmented cervix . the tentative plan for this was to establish the lower limit of uterus and upper limit of neovagina and henceforth , suture them together . a longitudinal incision was given over fundus of the uterus with harmonic scalpel and a suction cannula was passed through this incision till the lower limit of uterus . however , utero - vaginal anastomosis could not be performed , because the intervening distance in this patient was so much that mobilization of the uterus was not technically possible and the procedure had to be abandoned . later , this patient got married and presented to us again after 5 years of initial treatment with left lower abdominal pain . she reported satisfactory coital function and her husband had two issues from his previous marriage . sonographic evaluation showed another endometriotic cyst ( 11 cm  8 cm ) in left ovary . the case was discussed with the patient and her family and prognosis regarding reproductive potential was explained . they decided in favor of hysterectomy and the patient was taken up for laparoscopy again . on inserting the laparoscope , a pelvic mass was visualized which was formed by a jumble of dilated left tube , left ovarian cyst with left ovary , and loops of small bowel which were all matted together [ figures 1 and 2 ] . a hysterectomy was planned so round ligament and infundibulopelvic were cut with harmonic on the left side . carefully , upper limit of bladder was determined with the help of a bougie inside the bladder . uterine arteries could not be seen on either side even after a conscious attempt and dissection and the uterus seemed to be deriving its entire blood supply from the ovarian and tubal vessels . uterus with left tube and ovary were separated from the underlying loose peritoneal fold [ figure 3 ] with the help of harmonic which completed the hysterectomy then the uterus was morcellated and removed [ figures 4 and 5 ] . cystoscopy was done after the procedure which revealed an ectopic position of left ureteric opening . dense adhesion of omentum covering the entire uterus , left tube and ovary totally jumbled mass of dilated left tube and ovarian cyst loose fold of peritoneum replacing the cervix final picture after hysterectomy with left salpingo - oopherectomy congenital cervical anomalies are classified as type ib in the american fertility society classification of mullerian anomalies . they can further be classified into complete agenesis and dysgenesis where , congenital agenesis of the cervix is a rare condition . hence , thorough pre - operative work - up including an intravenous urograph is mandatory . diagnosis is suspected on the basis of history , clinical examination , and ultrasonography and can be confirmed by means of magnetic resonance imaging . differentiation from a high vaginal septum can be made as there is no vaginal dilatation with the accumulation of blood due to an absent passage - way . conservative laparoscopic surgery consisting of uterovaginal anastomosis has also been described and recommended as first line treatment by some authors . in our own experience , conservative management is a better treatment option in cases of cervical fragmentation and dysgenesis . our purpose of reporting , this case is to highlight the need to individualize treatment in all such patients of cervical anomalies . while , we also recommend uterovaginal anastomosis as the first line of management , both surgeon and the patient should be prepared for hysterectomy , especially , in extreme cases like this . this will save repeated morbid procedures as well as financial and psychological burdens as correct decisions help provide timely management to the patient .
we report a case of cervical agenesis or lack of uterine cervix . 
 it is a rare mullerian anomaly and occurs in 1 in 80,000 - 100,000 births . 
 the patient presented to us with primary amenorrhea and cyclical left lower abdominal pain . 
 she was diagnosed to have cervical agenesis associated with vaginal agenesis and left endometriotic cyst . 
 neovagina was created laparoscopically . 
 utero - vaginal anastomosis was tried but it was not technically feasible . 
 subsequently , laparoscopic hysterectomy was done due to recurrent endometriotic cyst formation .