PMC5779782_01
Magnetic resonance imaging scan showing (A) distinct cervices (yellow arrow) and no obvious low vagina (red arrow). (B) The septum is causing exaggerated separation of the cavities (red arrow).
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F1
For further evaluation, she was examined preoperatively with magnetic resonance imaging; the scan showed distended endometrial cavities and cervical canals, which were misdiagnosed as a lower obstructed vagina, 1-cm long duplication of a normal cervical zonal anatomy, and complete septate uterus (Fig. 1).
Surgical view (A) short vagina with a pored cervical structure at the top. (B) Laparoscopic view of the enlarged uterus with an asymmetric, small indentation at the top.
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F2
On physical examination, she was found to have no development of hymenal remnant tissue and a vagina of adequate caliber but only 3 cm long at the apex, of which there was patency with one fingerbreadth at the site of the suspected vaginal stricture secondary to the first operation (Fig. 2A). The speculum examination showed the ovaries and fallopian tubes, which were unremarkable, but the structure of the cervical ligament was unclear (Fig. 2B).
Features of the patient's condition: (1) complete septate uterus with asymmetric cavities, (2) agenesis cervix with a small hole, and (3) upper vaginal atresia (punched and shaped 10 years ago).
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F3
In this patient, the congenital combination of upper vaginal atresia, cervical agenesis, and complete uterine septum was identified (Fig. 3).