Management of congenital absence of the cervix: A case report

Cervical agenesis or dysgenesis is an extremely rare congenital anomaly. Conservative surgical approach to these patients involves uterovaginal anastomosis, cervical canalization, and cervical reconstruction. In failed conservative surgery, total hysterectomy is the treatment of choice. Success of reconstructive surgery depends on the amount of cervical tissue available. Hence, congenital absence of the cervix is a complex surgical problem and should be dealt with after thorough evaluation. We report an 18 year old girl presented with primary amenorrhoea and cyclic monthly abdominal pain. Initial attempted reconstructive surgery failed and hysterectomy was done. At laparotomy, there was only fibrous tissue and no cervical tissue at all. No findings related to endometriosis were observed .The uterus was removed and sectioning the fibrous tissue level of the blind vaginal cuff. Gross tissue examination showed a non communicating uterine cavity, filled with menstrual blood of about 200mls and a diffusely hypertrophy myometrium. The cervix was absent. Microscopically, there was no cervical tissue in the specimen; the uterine muscles had evidence of adenomyosis. In conclusion, re-canalization and cervical reconstruction procedures may be performed on carefully selected patients, consideration should be directed to the presence of adequate cervical stroma absence of which warrants hysterectomy.

Keywords
Cervical atresia; cervical agenesis/dysgenesis; cervical fragmentation/uterine malformations; haematometra; Tanzania