Congenital vaginal oblique septum syndrome: clinical features and diagnostic value of imaging examinations

doi:10.3877/cma.j.issn.1672-6448.2022.10.007

Abstract

Abstract:

Objective

To explore the clinical features of congenital vaginal oblique septum syndrome (OVSS) and assess the value of imaging examinations in the diagnosis of this disease.

Methods

The clinical and imaging data of 102 patients with OVSS who underwent surgery at Peking Union Medical College Hospital from January 2017 to April 2022 were retrospectively analyzed. The clinical characteristics of OVSS were summarized, and the diagnostic value of ultrasonography and magnetic resonance imaging (MRI) for different types of OVSS was assessed by using surgical and pathological results as the diagnostic criteria.

Results

Of 102 cases of OVSS included, 30 were type Ⅰ, 43 were type Ⅱ, 15 were type Ⅲ , and 14 were type Ⅳ. The onset age and time interval from menarche to onset of type Ⅰ were significantly lower than those of the other three types (P＜0.05 for all). The incidence of dysmenorrhea and abdominal pain in type Ⅰ (83.33%) and type Ⅳ (100%) was significantly higher than that in type Ⅱ (44.19%) and type Ⅲ (40.00%) (P＜0.05 for all). The incidence of prolonged menstrual duration in type Ⅲ (46.67%) was significantly higher than that in type Ⅰ (10.00%) and type Ⅳ (0) (P＜0.05 for both). The incidence of purulent vaginal secretions in type Ⅱ (25.58%) was significantly higher than that in type Ⅰ (0) (P＜0.05). There were 56 cases (56/102, 54.90%) of right vaginal oblique septum, and all cases were complicated with absence of the right kidney (54.90%). There were 46 cases (46/102, 45.1%) of left vaginal oblique septum; 43 cases (42.16%) had absence of the left kidney, and 1 case (0.98%) had left renal dysplasia. All of the 102 patients underwent ultrasound examination; 92 cases were correctly diagnosed as having uterus duplex and double cervix, and 7 were correctly diagnosed as having complete septate uterus. The coincidence rate between ultrasound diagnosis and operation was 97.06% (99/102). Eighty-two patients underwent MRI examination, of which 72 were correctly diagnosed with uterus duplex, and 5 were correctly diagnosed with complete septate uterus. The coincidence rate of MRI diagnosis and operation was 93.90% (77/82). All of the 102 patients underwent vaginal septum resection, of which 55.88% (57/102) underwent laparoscopic exploration combined with vaginal septum resection, and 19.61% (20/102) underwent hysterectomy on the affected side. The incidence of ovarian endometriosis cyst in type Ⅳ was significantly higher than that in type Ⅰ and type Ⅱ (P＜0.05 for both). Laparoscopic exploration combined with vaginal septum resection and hysterectomy was significantly more commonly used in type Ⅳ than in other 3 types (P＜0.05 for all).

Conclusion

Different types of OVSS have different clinical characteristics. Ultrasound and MRI can be used for early diagnosis of OVSS and its complications, which can provide important information for the formulation of surgical plan.

Key words: Uterus, Ultrasonography, Vaginal oblique septum syndrome, Magnetic resonance imaging

Mengsu Xiao, Qing Dai, Zhenhong Qi. Congenital vaginal oblique septum syndrome: clinical features and diagnostic value of imaging examinations[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(10): 1058-1064.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2022.10.007

https://chaosheng.cma-cmc.com.cn/EN/Y2022/V19/I10/1058

Figures/Tables 4

References 21

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临床特征	Ⅰ型（n=30）	Ⅱ型（n=43）	Ⅲ型（n=15）	Ⅳ型（n=14）	P值
发病年龄［岁， M（P₂₅，P₇₅）］	12.00（12.00，14.00）	21.00（14.00，28.00）^a	23.00（14.00，25.00）^a	17.50（13.75，29.25）^a	＜0.001
初潮年龄［岁， M（P₂₅，P₇₅）］	12.00（11.00，13.00）	13.00（12.00，14.00）	13.00（12.00，14.00）	12.00（12.00，13.00）	0.209
初潮至发病时间间隔［岁，M（P₂₅，P₇₅）］	1.00（0.5，1.75）	7.50（1.93，15.25）^a	9.00（1.00，13.00）^a	5.50（1.75，15.50）^a	＜0.001
痛经及腹痛	25（83.33）	19（44.19）^ab	6（40.00）^ab	14（100.00）	＜0.001
阴道出血淋漓不尽	3（10.00）	10（23.26）	7（46.67）^ab	0	0.006
阴道脓性分泌物	0	11（25.58）^a	2（13.33）	0	0.003
子宫宫腔积血	8（26.67）	7（16.28）	2（13.33）	7（50.00）	0.052
阴道隔后腔积血	30（100.00）	20（46.51）^a	3（20.00）^a	0^a	＜0.001
卵巢子宫内膜异位囊肿	1（3.33）^b	3（6.98）^b	1（6.67）	6（42.86）	0.003
腹膜和（或）盆腔子宫内膜异位症	0	12（27.91）^a	4（26.67）^a	3（21.43）	0.004
阴道斜隔切除术	8（26.67）	11（25.58）	5（33.33）	1（7.14）	0.389
腹腔镜探查联合阴道斜隔切除术	20（66.67）^b	27（62.79）^b	9（60.00）^b	1（7.14）	0.001
患侧子宫切除术	2（6.67）^b	5（11.63）^b	1（6.67）^b	12（85.71）	＜0.001

临床特征	Ⅰ型（n=30）	Ⅱ型（n=43）	Ⅲ型（n=15）	Ⅳ型（n=14）	P值
发病年龄［岁， M（P₂₅，P₇₅）］	12.00（12.00，14.00）	21.00（14.00，28.00）^a	23.00（14.00，25.00）^a	17.50（13.75，29.25）^a	＜0.001
初潮年龄［岁， M（P₂₅，P₇₅）］	12.00（11.00，13.00）	13.00（12.00，14.00）	13.00（12.00，14.00）	12.00（12.00，13.00）	0.209
初潮至发病时间间隔［岁，M（P₂₅，P₇₅）］	1.00（0.5，1.75）	7.50（1.93，15.25）^a	9.00（1.00，13.00）^a	5.50（1.75，15.50）^a	＜0.001
痛经及腹痛	25（83.33）	19（44.19）^ab	6（40.00）^ab	14（100.00）	＜0.001
阴道出血淋漓不尽	3（10.00）	10（23.26）	7（46.67）^ab	0	0.006
阴道脓性分泌物	0	11（25.58）^a	2（13.33）	0	0.003
子宫宫腔积血	8（26.67）	7（16.28）	2（13.33）	7（50.00）	0.052
阴道隔后腔积血	30（100.00）	20（46.51）^a	3（20.00）^a	0^a	＜0.001
卵巢子宫内膜异位囊肿	1（3.33）^b	3（6.98）^b	1（6.67）	6（42.86）	0.003
腹膜和（或）盆腔子宫内膜异位症	0	12（27.91）^a	4（26.67）^a	3（21.43）	0.004
阴道斜隔切除术	8（26.67）	11（25.58）	5（33.33）	1（7.14）	0.389
腹腔镜探查联合阴道斜隔切除术	20（66.67）^b	27（62.79）^b	9（60.00）^b	1（7.14）	0.001
患侧子宫切除术	2（6.67）^b	5（11.63）^b	1（6.67）^b	12（85.71）	＜0.001

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