Vol. 1, No.

2, Jul-Dec 2017
ANDALAS OBSTETRICS AND GYNECOLOGY JOURNAL
Alamat Korespondensi:
Ruang Redaksi Andalas Obstetrics and Gynecology Journal, Lantai 3 PPDS Obstetri dan Ginekologi Universitas
Andalas, RSUP DR. M. Djamil Padang, Jl. Perintis Kemerdekaan Padang, Sumatera Barat 25127

Website:
eISSN : 2579-8324 pISSN : 2579-8323
http://jurnalobgin.fk.unand.ac.id/index.php/JO
E

CASE REPORT
Transverse vaginal septum
Bobby Indra Utama1, Ermawati2
Affiliations : 1. Sub Division of Urogynecology, Obstetrics and Gynecology Department, Faculty of
Medicine, Andalas University, Dr. M. Djamil Central General Hospital Padang; 2. Sub Division of
Urogynecology, Obstetrics and Gynecology Department, Faculty of Medicine, Andalas University,
Dr. M. Djamil Central General Hospital Padang
Correspondence: Bobby Indra Utama, email: [email protected], Hp: 08116660500

Abstract
The vagina is a membranous muscular tube that connects the vulva and uterus. Congenital or
congenital abnormalities in the form of complete or partial absence of the vagina (vaginal agenesis).
Patients who experience vaginal agenesis have less frequency, namely 1 in 4000 births, 1 in 4000 to
10,000 births (ACOG). Meanwhile in Dr. Cipto Mangunkusumo Jakarta from 1995 to 1999, an
average
of 10-12 cases per year. It has been reported the case of a female patient aged 14 years who entered
the Gynecology Ward Dr. M. Djamil Padang on January 25, 2014 at 11.00 WIB with a delivery from
the RSMJ gyn clinic with a diagnosis of transverse vaginal septum + hematometra + hematotrachelos
+ hematokolpos planned for a septal incision. After performing the operative action, ± 500 cc of
blackish brown liquid was successfully removed.
Keywords: Agenesis Vagina, TVS, Tranverse Septum Vagina, Case Report

INTRODUCTION
The vagina is a musculoskeletal membrane that connects the vulva and uterus. The vagina is
located between the bladder and rectum. The function of the vagina is mainly to have sexual
intercourse, a path for the fetus at birth or parturition, fluid excretion channels especially
menstrual blood, besides being required by doctors and uterine diseases to find out the
internal genitalia tool by internal examination.1,2,3,4,5
Congenital abnormalities in the form of complete absence of the vagina or part (vaginal
agenesis) will certainly cause problems for sufferers of one of the three things function,
especially giving complaints of not being able to have sexual intercourse and menstrual
bleeding. A very severe congenital abnormality is the absence of the vagina at all.5,6,7
Patients who experience vaginal agenesis are not very frequent, namely 1 in 4000 births
(Bryan et al,
1949), 1 in 4000 to 10,000 births (ACOG). Whereas at the hospital Dr. Cipto Mangunkusumo
Jakarta since 1995 Until 1999, an average of 10-12 cases per year had undergone
reconstruction of new vaginal making for cases with vaginal agenesis (Rokintansky Hauser
syndrome) and some patients with vaginal agesis did not require surgery to make a new
vagina.5,6,8 Vaginal agenesis was the cause the second largest in primary amenorrhoeic cases
after gonadal dysgenesis.8,9,10

80
Received 5 Jun 2017
Accepted 6 Jun 2017
Correspondence: Bobby Indra Utama, email: [email protected]
 Appropriate action and careful motivation from doctors to determine the form and
timing of therapy given to patients and their families is very important in the effort to
achieve successful treatment.5,6,7
This was reported a case in which a 14-year-old woman came to the gynecology clinic
with complaints that the lower abdomen felt swollen since 8 months ago, and the patient
had not had menarche.

CASE REPORT
A female patient aged 14 years, with complaints Patients complained of swelling in the
lower abdomen since ± 8 months ago, the swelling was felt increasingly getting bigger, pain
(+), Pain felt every month since ± 1 year ago, the patient has not had menarche, sign
secondary sex of the patient has appeared.
Examination of the abdomen shows: it appears to swell up like a 5 month pregnancy,
palpable mass of 2 fingers above the center, no pain in palpation, in dim percussion above
mass, BU (+) normal. In the inspection of the vagina by inspection the hymenal tissue was
obtained (+). In the examination of the rectal touche the impression of the uterine corpus
was as large as the baby's head. On ultrasound examination, the impression is:
hematometra, hematotrachelos, hematokolpos.

From the whole examination results the patient was diagnosed with: Transverse
vaginal septum + hematometra + hematotrachelos + hematokolpos.
 In this patient the septum incision is performed. At the time of surgery, after the
septum incision was released brown liquid + 500 cc, no abnormalities were seen in the
portio and vagina, then the incision wound was sewn back by interupted with vicryl 3-0.

DISCUSSION
A case of a 14-year-old female patient has been reported to enter the Gineokology
Department Dr. M. Djamil Padang on January 25, 2014 at 11.00 WIB from the RSMJ
gynecology clinic with a diagnosis of transverse vaginal septum + hematometra +
hematotrachelos + hematokolpos planned for septum incision. After the operative action
was successfully removed ± 500 cc of blackish brown liquid.
 Congenital abnormalities in the form of complete absence of the vagina or part
(vaginal agenesis) will certainly cause problems for sufferers of one of the three things
mentioned above, especially giving complaints of not being able to have sexual intercourse
and menstrual bleeding.
The diagnosis of vaginal abnormalities including vaginal agenesis in newborns is rarely
made, because to make the diagnosis requires careful accuracy in carrying out the
examination. It is necessary to examine the vaginal sonde and rectal examination to
determine the depth of the vagina and the presence or absence of the uterus. But this is
rarely done because it is difficult and if there are known abnormalities, therapy will also not
be done immediately. Therapy will be postponed until the body condition is perfect and
mature (after menarce).
In this patient after a complete examination concluded with a diagnosis of
hematometra + hematotrachelos + hematokolpos + transverse vaginal septum. Then a
transverse septum incision is made by installing a drain. The choice of action in this patient
is a consideration for maintaining the normal uterus as its reproductive function, as is done
in patients with cervical canal obstruction.
Based on reference, the diagnosis can easily be made when the woman has experienced
puberty, where the sufferer experiences primary amenorrhea, while the development of
secondary sex is normal. In sufferers who are have abnormalities of the vagina with the
uterus, will get an intra-abdominal tumor (hematometra) or sometimes easily found
hematokolpos with prominent imperforata or vaginal hymen due to the urge of menstrual
blood down into the vagina.
In another case, laparoscopy and drainage were performed as a new treatment option
in the management of transverse vaginal septum, ie in a 14-year-old patient at Auckland's
National Women's Women's Hospital with pain recurrent pelvic and amenorrhea ai
hematokolpos in the uterus the right delphys with normal external genitalia; then in an 11-
year-old patient at Melbourne's Royal Children's hospital with abdominal pain ai
hematokolpos with a low transverse septum and refused to use postoperative vaginal mold;
and in the case of a 16-year-old girl in Melbourne with hematokolpos, hematometra and
uterus bicornu.
In this patient, diagnose of hematokolpos was strengthened by USG examination then
the reason for not doing chromosome analysis in this patient was due to normal secondary
sex growth. When compared with several similar cases, the consideration of maintaining the
uterus as its reproductive function because the uterus is normal.

CONCLUSION
Transverse septum can form during embryogenesis when the mullerian duct merges
imperfectly to form urogenital sinus. A complete transverse septum will inhibit menstrual
flow and cause primary amenorrhea. Some transverse septums are incomplete and can
cause dysparenia and obstruction in labor

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