Therapeutic Strategy for Hematometra With Anorectal Anomaly

Abstract

We examined the therapeutic strategy for two cases of hematometra with anorectal malformations. Case 1: The diagnosis of this patient was anovestibular fistula, double vagina, and double uterus. The patient underwent uterovaginal fenestration by a laparotomy for hematometra due to uterocervical atresia. The fenestration closed spontaneously, and the patient received abdomino-perineal fenestration of the vagina with stent placement. Since the removal of the stent at 7 months after surgery, menstrual blood excretion disorder has not occurred. Case 2: The diagnosis was a persistent cloaca, deficiency of the colon, and double uterus. The patient received double uterovaginal anastomosis with stent placement by a laparotomy for hematometra, hemosalpinx, and uterocervical atresia. After removal of the stent, the hematometra and hemasalpinx on both sides became aggravated. The patient underwent abdomino-perineal fenestration of the right side vagina with stent placement and a left hysterectomy. Since the removal of the stent at 29 months after surgery, menstrual blood excretion disorder has not occurred. Immediate treatment is required for patients with hematometra due to abdominal pain and intrauterine infection. Although stent placement assists in postoperative stenosis of uterovaginal anastomosis or fenestration, there are some problems, including discomfort during stent placement or accidental stent removal. Physicians should therefore carefully determine both the type of stent required and the term of stent placement.