PMC9634117_01
PMC9634117_02
Imaging findings and outpatient hysteroscopic images of the patient. (A-C) Pelvic MRI showed a large amount of effusion in the middle and upper segments of the vagina and that the lower segment of the vagina was adhered to the bladder neck. (D) Pelvic ultrasound showed hydrocolpos (range, approximately 7.5 cm x 7.2 cm x 6.5 cm) with a flocculent echo. (E,F) Outpatient hysteroscopy revealed a small hole at the top of the vagina, which was blocked by a transverse fold, and the cervix was not observable.
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F1
On May 10, 2019, she presented to our hospital outpatient department and underwent pelvic magnetic resonance imaging (MRI) that revealed a large effusion in the middle and upper segments of the vagina and the lower segment of the vagina as being adhered to the bladder neck (Figures 1A-C). Transabdominal pelvic ultrasonography revealed normal uterus and bilateral adnexa, and hydrocolpos (range, approximately 7.5 cm x 7.2 cm x 6.5 cm) with a flocculent echo (Figure 1D). A small hole, which was obstructed by a transverse fold and not easily visible (Figures 1E,F), was identified.
Hysteroscopic and ultrasonic images of the patient during operation. (A) A small hole with a diameter of approximately 1.5 mm was seen at approximately 6 o'clock of the top of the vagina. (B) An epidural catheter was inserted through the hole. (C) Dark red fluid was observed on suction. (D) An injection of 20 ml methylene blue was administered through the epidural catheter. (E,F) A fluid flow shadow in the vaginal mass was observed after injection of methylene blue under ultrasonography. (G,H) A large amount of sloughy pus was observed attached to the vaginal wall and cervix. (I) A needle electrode was used to release the adhesion to the vaginal wall longitudinally.
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F2
After careful exploration, a small hole with a diameter of approximately 1.5 mm was seen at approximately the 6 o'clock position (Figure 2A), and the hysteroscope could not be advanced further. An epidural catheter was inserted through the hole using the 5 Fr operative channel of the hysteroscope (Figure 2B), and dark red fluid was observed on suction (Figure 2C). Methylene blue (20 ml) was then administered through the epidural catheter (Figure 2D), and a fluid flow shadow in the vaginal mass was observed under ultrasonography (Figures 2E,F). After sufficient flushing, the hysteroscope was re-inserted, and on entering the upper segment of the vagina, a large amount of sloughy pus was observed attached to the vaginal wall and cervix (Figures 2G,H). After flushing out the pus and further dilating the hole, a 10-mm resectoscope with an electrical needle was used to longitudinally release the vaginal wall adhesion with 80 W power (Figure 2I).
Outpatient hysteroscopic and ultrasonic images 3 months after operation. (A,B) Hysteroscopy showed that the surgical wound healed well. (C) The cervix could be observed. (D) A pelvic ultrasound showed no abnormalities.
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F3
Three months postoperatively, hysteroscopy showed a well-healed surgical wound (Figures 3A,B) and identifiable cervix (Figure 3C). Pelvic ultrasonography showed no abnormalities (Figure 3D).