e52 Poster Abstracts / J Pediatr Adolesc Gynecol 28 (2015) e41ee78

The present case suggests that premenarcheal oscillation of repro- manner. None of the 4 victims sustained infectious sequelae. Outcomes of
ductive hormones might exert a cyclic effect on the brain resulting in these assaults resulted in imprisonment in 3 cases, although one perpe-
behavior equivalent to adult premenstrual disorders. trator was never identified.
Case 1: A 2 year old white female toddler whose injuries included a
midline third degree perineal laceration measuring 4 cm in length,
27. Partial Cervical Agenesis and Complete Vaginal
extending to a depth of 2.5 cm, transecting the hymen, perineal body and
Atresia: A Case Study
the anal sphincter. The posterior vaginal fornix was lacerated from 4-11
o’clock at the level of the cervico vaginal junction, and the overlying
Kimble RMN, MBBS, FRANZCOG*, G. Molloy MBBS, B. Sutton MBBS, peritoneum was intact.
FRANZCR, Dip Fetal Medicine Case 2: A 7 year old biracial female child whose injuries included a large
Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia third degree mediolateral vaginal laceration located at the 8 o’clock posi-
tion, extending from the perineum to the vaginal apex, rupture of the
Background: The combination of partial cervical agenesis and complete posterior vaginal fornix from the 4-10 o’clock position penetrating through
vaginal atresia is a rare variation of obstructive mu € llerian abnormalities the peritoneum with secondary evisceration of the small bowel. The broad
that can present with primary amenorrhea and cyclical pelvic pain. The ligament was lacerated on the right side extending from the mid-portion
challenges of accurate diagnosis of complete or partial cervical agenesis by of the uterus to the right pelvic side wall with associated contusion of the
using magnetic resonance imaging and subsequent complexity of right ureter.
balancing surgical and non-surgical management can lead to significant Case 3: A 12 year old postmenarchal black female whose injuries included
morbidity and mortality. a laceration of the posterior vaginal fornix extending from the 4 to 8
This manuscript examines two cases of complete vaginal atresia with o’clock position at the level of the cervico vaginal junction with small
partial cervical agenesis diagnosed on histology specimens after hyster- bowel evisceration.
ectomy. The incongruency of clinical, surgical, imaging and histological
diagnosis of cervical anatomy, made it difficult to definitively treat the
patient in the initial period.
Case Summary: Two cases of partial cervical agenesis and complete
vaginal atresia are discussed in this manuscript. Both Girls were treated at
a tertiary Paediatric and Adolescent Gynaecology service both at age
fourteen with cyclical abdominal pain and amenorhoea.
Patient one’s initial investigations showed complete vaginal agenesis,
an atretic cervix and normal uterus. A neovagina was surgically created
and she was commenced on oral contraception. She initially had good
resolution of her symptoms. Six years after her initial surgery, she devel-
oped a pelvic infection, which was responsive to antibiotics and after
discussion at this time, declined a hysterectomy. However, on her next
presentation, she was clinically septic with a severe pelvic infection. She
was treated with antibiotics until her sepsis resolved, followed by a hys-
terectomy during the same admission.
Patient two was initially diagnosed with an absent vagina and hae- Ă
Case 4: A 15yo mentally disabled black female whose injuries included
matometro-colpos at a regional hospital. Her menses were suppressed and
hemostatic hymenal lacerations at the 3, 6 and 9 o’clock positions. A 2 cm
her care was transferred to the tertiary PAG service. After an initial MRI,
defect in the posterior fornix extending from the 3-9 o’clock position
which demonstrated normal uterus and cervix and a small portion of
consistent with a vaginal rupture injury with penetrance into the pelvic
upper vagina, she was taken to surgery for creation of a neovagina. Six
cavity and an associated hemoperitoneum.
months after her initial presentation, she developed a severe pelvic
infection requiring surgical management and developed septic shock. She
Comments: Traditionally, the management of assault victims has focused
on the forensic, psychosocial and transmissible disease aspects. However
was admitted to intensive care unit requiring inotropic and vasopressor
the victim with a severe and sometimes life-threatening injury such as a
support. She was commenced on Extra-corporeal membrane oxygenation
vaginal rupture injury (colporrhexis) needs to be detected and treated
for four days. After resolution of her multiorgan failure, she was taken back
promptly. In consideration of this there should be a low threshold for
to theatre and had a large pelvic abscess drained. After 3 months of closely
managing them primarily as a trauma case, proceeding expeditious to
observed recovery, she underwent a laparotomy and hysterectomy.
examination under general anesthesia when appropriate, while simulta-
Summary and Conclusions: These cases highlight the difficulties
neously providing due emphasis on the psychological and forensic com-
associated with interpretation of diagnostic imaging for this combination
ponents of their care.
of mu € llerian abnormalities, and the importance of early definitive treat-
ment in these cases. It also impresses upon the management complexities
in relation to counselling of patients and their parents to proceed to hys-
29. Operative Time of Pediatric Ovarian Cystectomies
terectomy early, to prevent what can be life threatening sepsis.
According To Cyst Size

28. Case Series of Vaginal Rupture Following Sexual Emma A. Carroll, Xiomara Santos MD, Jennifer L. Bercaw-Pratt MD,
Assault Abraham, M MD, Merritt, D MD Haleh Sangi-Haghpeykar PhD, Jennifer E. Dietrich MD, MSc*
Baylor College of Medicine Houston, TX, USA
M. Abraham MD, D. Merritt MD
Department of Obgyn, Washington University, St. Louis, MO Background: As the health care system continues to face the paradox of
growing demand for services and limitations on resources and funding,
Background: Vaginal rupture (colporrhexis) following sexual assault is a medical professionals will be required to develop innovative ideas to
rare but life threatening occurrence. This injury is associated with signif- provide efficient and effective medical care. With this in mind, a retro-
icant hemorrhage, prompt recognition and treatment is necessary to spective quality improvement study was performed to assess pediatric
prevent hemorrhagic shock and mortality. The purpose of our case series is ovarian cystectomy operating time and whether it is influenced by cyst
to increase our awareness by describing four cases of vaginal rupture size. The results of this study will help clinicians to schedule OR time more
following sexual assault in young patients aged 2-15 years old. efficiently.
Each patient had in common a vaginal apical rupture injury with sec- Methods: This study was approved by the Institutional Review Board and
ondary acute blood loss anemia. Only one case was recognized in a timely Baylor College of Medicine. A retrospective chart review was conducted on