A combined surgical and radiologic technique for creating a functional neo-endocervical canal in a case of partial congenital cervical atresia

Objective: To recanalize the endocervical canal in a patient with partial congenital cervical atresia. Design: Case report. Setting: University hospital. Patient: A 16-year-old girl referred with a history of primary amenorrhea, polycystic ovaries, and intermittent abdominal pain. Physical examination revealed a normal vagina and external cervical os, but magnetic resonance imaging revealed a solid endocervical tract. Intervention(s): At laparotomy the endometrial cavity was accessed transfundally and outlined by injection of water-soluble contrast. A trocar needle was guided transvaginally into the uterus, the tract was dilated, and a 12F stent was placed. Oral contraceptives (OCs) and antibiotics were continued postoperatively. Main Outcome Measure(s): Hysterosalpingography and clinical follow-up. Result(s): The operation and postoperative course were uneventful. Withdrawal bleeding occurred at 8 weeks, after discontinuation of the OCs, at which time the stent was expelled. Later follow-up revealed recurrent narrowing, and the stent was replaced for 14 more weeks. After stent removal, regular menses continued (7 months to date). Conclusion: In select cases of congenital cervical atresia, recanalization may be safely performed with the use of the combined surgical-radiologic technique described, with good short-term outcome. (C) 1998 by American Society for Reproductive Medicine.