DISTAL VAGINAL AGENESIS PRESENTING WITH FECAL RETENTION FROM AN ABDOMINOPELVIC MASS

Problem Statement
Distal vaginal agenesis is a rare form of female genital tract malformation that presents as cryptomenorrhea. It results from the failure of the urogenital sinus to form the caudal portion of the vagina. Through a thorough history, physical examination and appropriate imaging studies, an accurate diagnosis is integral in selecting the correct intervention for the patient.

Methods
This is a case report of distal vaginal agenesis in a 10-year-old nulligravid, who presented with fecal retention from an abdominopelvic mass.

Results
The index patient had no bowel movement for 4 days, and abdominal enlargement. On inspection, there was a 12.0 x 10.0 cm abdominal mass from the hypogastric region up to the umbilicus. Inspection of the external genitalia, the introitus appeared concave, with no appreciable introital opening. On digital rectal examination, an anterior bulge was palpated 0.5 cm from the anal verge. Transrectal/transabdominal ultrasound was performed to support the clinical findings. A pull-through vaginoplasty was performed with an unremarkable post-operative course. The patient was discharged with a patent vagina and resolution of her gastrointestinal symptoms. On follow-up, the patient had monthly menstruation after surgery with no recurrence of her gastrointestinal symptoms.

Conclusion
Distal vaginal agenesis is a rare female genital tract malformation but should be included in possible differentials in cases presenting with a possible vaginal outflow obstruction. This case highlights the importance of a good history, complete physical examination and appropriate diagnostic work-up in patients presenting with no bowel movement, abdominal pain and a palpable hypogastric mass, with the consideration of a possible vaginal outflow obstruction. A good examination of the genitalia and a good understanding of the anatomy of each individual case is important in determining the best surgical approach.