Clinical and surgical management of congenital cervical outflow obstruction variants in adolescents

Abstract

• Congenital anomalies of the uterine cervix are rare Müllerian duct development disorders that present significant management challenges. Obstruction of menstrual outflow typically leads to hematometra, causing cyclical pelvic pain and primary amenorrhea. However, presentation can vary greatly depending on uterine anatomy and collection volume. This series reports two distinct presentations of congenital cervical obstruction managed at a tertiary municipal hospital in Mumbai. Case 1 describes a 14-year-old female presenting with primary amenorrhea, severe cyclical abdominal pain, and an anatomical variant featuring a blind vaginal canal, single-sided hematometra with a contralateral rudimentary horn, massive right-sided hematosalpinx, and extensive secondary pelvic endometriosis. She successfully underwent an isthmo-vaginal anastomosis, right salpingectomy, and deposit excision. Case 2 presents a 16-year-old female with primary amenorrhea who was notably asymptomatic for cyclical pain. Pelvic MRI confirmed a subseptate uterus with two non-communicating, asymmetrical endometrial cavities containing restricted blood products, separated from the cervix by a 3–4 mm fibrous tissue band. She successfully underwent surgical resection via an isthmo-cervical anastomosis, intraoperative drainage of dual mucoceles, and fimbrial adhesiolysis. These cases illustrate the diverse clinical spectrum of congenital cervical obstruction. While Case 1 showcases severe retrograde complications, Case 2 demonstrates that small-volume, non-communicating septate cavities can present asymptomatically without cyclical distress. Meticulous multiplanar MRI evaluation and individualized reconstructive surgery are vital to preserving anatomy and long-term fertility.