oblique vaginal septum
Introduction
Introduction to vaginal sloping Vaginal sulcus is a genital malformation that is not very rare. The clinical manifestations are peculiar and often cause delays in diagnosis and treatment. There are no or very few introductions in general textbooks. The definition of vaginal septum mainly includes the following aspects: 1. Double uterus and double cervix, individual may have a single cervix combined with uterine mediastinum. 2. Vaginal oblique septum, which is different from the vaginal mediastinum that divides the vagina into two sides, and is different from the vaginal diaphragm that divides the vagina into upper and lower sections. The vaginal oblique septum is a membranous tissue with vaginal epithelium on both sides, originating from the two cervix, obliquely attached to one side of the vaginal wall, forming a blind tube to cover the cervix on the side, separated There is a cavity between the rear and the cervix as a "separated cavity". 3. Urinary malformations, almost without exception, the lack of kidney and ureter on the same side of the oblique septum. The case was first reported in the literature in 1992, but there is no suitable name, and some are named "uterusdidelphyswithunilateralimperforatevagina". Because this deformity is prominent in the vagina with a diagonally attached septum, it is most appropriate to call it the vaginal septum syndrome. basic knowledge The proportion of illness: 0.001% Susceptible people: women Mode of infection: non-infectious Complications: pelvic abscess endometriosis
Cause
Cause of vaginal septum
Congenital factors (35%):
During the embryonic period, the predecessor of the female genital tract, the Miller tube, is a bilaterally symmetrical bilateral duct. Later, through a series of steps such as midline fusion and septal absorption, a single uterus, cervix and vagina are finally formed on the midline. While still maintaining the left and right fallopian tubes, the process is about 5 weeks from the embryo until 16 weeks. During this period, if the progress of the above process is hindered due to the influence of teratogenic factors, different degrees of double uterus can be caused. Double cervical and vaginal malformations occur.
Pathogenesis
The specific mechanism of the occurrence of asymmetrical malformation of the vaginal septum is still unclear. The Miller tube is closely related to the occurrence of the middle kidney tube. The development of the Miller tube depends on the development of the middle kidney tube, and the development of the middle kidney tube is blocked. The development of the tube is also abnormal, resulting in a series of asymmetric deformities of the kidney, ureter and vaginal development. The lesions of the vaginal septum are divided into the following three types:
1. Type I: non-porous oblique separation, no holes on the diagonal partition.
2. Type II: There is a perforated slanting partition, and there is a small hole in the slanting partition, and there is often a poor drainage of the sulcus.
3. Type III: non-porous oblique septum combined with cervical fistula, between the two sides of the cervix or between the posterior chamber and the contralateral cervix with fistula formation, there may be poor drainage.
The incidence of the disease is the highest in type II, accounting for about 50%.
Prevention
Vaginal oblique prevention 1. Maintain an optimistic and happy mood. Long-term mental stress, anxiety, irritability, pessimism and other emotions will make the balance of the cerebral cortex excitatory and inhibition process imbalance, so you need to maintain a happy mood. 2, life restraint pay attention to rest, work and rest, life orderly, maintain an optimistic, positive, upward attitude towards life has a great help to prevent disease. Do the regularity of tea and rice, live daily, not overworked, open-minded, and develop good habits. 3, reasonable diet can eat more high-fiber and fresh vegetables and fruits, balanced nutrition, including protein, sugar, fat, vitamins, trace elements and dietary fiber and other essential nutrients, meat and vegetables, diversified food varieties, Giving full play to the complementary role of nutrients in food is also helpful in preventing this disease.
Complication
Vaginal septal complications Complications pelvic abscess endometriosis
1. Pelvic infection: Common type II, type III patients, due to long-term empyema in the posterior cavity, when the resistance is reduced, it will cause acute inflammation, pelvic abscess.
2. Endometriosis: more common in type I patients, endometriosis caused by blood reflux.
Symptom
Vaginal oblique septum symptoms common symptoms vaginal transverse dysmenorrhea lower abdominal pain single or double uterus
1. Symptoms: The age of onset belongs to adolescents. The average time from menarche to major clinical symptoms is 1.7 years. The time of type I visit is earlier. Most unmarried women are dysmenorrhea. The main clinical symptoms are severe swelling, falling and sputum. Dysmenorrhea, in addition to the symptoms of infection such as vaginal discharge.
2. Signs: The general patients are mostly virgins, rarely vaginal examination, generally, such as vaginal examination, there is a small hole in the vagina, there may be pus outflow, sputum and vaginal wall mass, such tumors generally lower position Different from the common pelvic mass, it is fixed on one side of the vaginal wall and the dome.
Examine
Examination of vaginal septum
Vaginal secretion examination, CA125 examination.
1. B-ultrasound: It can prompt the double uterus and one side of the uterine blood to expand the cervix, which is very helpful for diagnosis, and can also prompt the lack of one side of the kidney.
2. Iodine oil angiography: I-type angiography see single-horn uterus and single fallopian tube malformation, type II angiography can be seen in the same single-horned uterus and unilateral fallopian tube, but if the posterior cavity is visible from the oblique septum, the uterus is generally difficult to develop after the septum Type III can develop the ipsilateral uterus from the cervix and the contralateral septum associated with it.
3. Laparoscopy: Double uterine malformations were found.
4. Urinary imaging examination: the lack of one side of the kidney and ureter.
Diagnosis
Diagnostic diagnosis of vaginal septum
The main point of diagnosis lies in the understanding of this disease. If there is no concept of vaginal septum syndrome, preoperative diagnosis is almost impossible. The difficulty in diagnosis lies in the contradiction of symptoms. These abnormalities have different degrees of obstruction, but because there is one side. Normal uterus and vagina, there will be a normal menstrual cycle, thus masking the existence of obstruction. The misdiagnosis rate of cases reported in the literature before 1985 is very high, about 80% misdiagnosed and open surgery, if the disease is sufficient Recognition, diagnosis is not difficult, combined with the fine and accurate B-ultrasound examination in recent years, can suggest the expansion of the double uterus and the cervix, and suggest the absence of the ipsilateral kidney, which is very important for the diagnosis.
Mainly with vaginal wall cyst perforation infection and pelvic mass identification, vaginal wall cyst and pneumonia sulcus local symptoms are the same, but B-ultrasound examination of urinary kidney is not difficult to identify, ovarian mass will also be incarcerated At the bottom of the pelvic cavity, but different from the mass caused by the oblique septum and the vaginal wall are integrated into one and can cause vaginal displacement deformation.
