小児子宮・腟病変の診断と治療方針選択における上部消化管内視鏡の有用性

抄録

　There are a variety of uterine malformations, but those with a closed cavity that present with severe dysmenorrhea require emergency opening of the cavity or removal of the isolated chamber. If misdiagnosed as functional dysmenorrhea, the condition can worsen and cause future pelvic endometriosis and infertility; however, children who have never had sexual intercourse are difficult to diagnose and treat because of the difficulty of outpatient transvaginal observation. There are no established methods for the diagnosis or treatment of uterine malformations in children, but there are scattered case reports of diagnostic treatment using morphological evaluation with MRI, and of transvaginal examination using a hysteroscope. The usefulness of upper gastrointestinal endoscopy has been reported in gynecology, but there are no reports of its application in pediatric uterovaginal lesions. We performed upper gastrointestinal endoscopy in two cases of pediatric uterine malformations.

　This procedure is excellent for vaginal observation because the upper gastrointestinal endoscope has very high resolution, its external diameter matches that of the vaginal inlet of the child, and the water-sealing maneuver maintains adequate water pressure. By contrast, hysteroscopic resectoscopy is superior to transvaginal incision manipulation. For intravaginal evaluation, laparoscopy should be used in combination with transvaginal manipulation if the diagnosis and treatment are difficult. All endoscopic devices are expected to be appropriate for the treatment of pediatric uterine malformations.