in which a section of ileum is isolated, and after intestinal continuity has been restored the isolated section is drawn down with its mesenteric blood supply to form a new vagina.
If a functioning uterus is present, it will usually be found that there is a patent cervix and an area of normal vaginal epithelium above the atresia, and that this epithelium can be freed by dissection and drawn down to the introitus.
In cases of congenital malformation of the vagina there are often also abnormalities of the ureters or kidneys, which should always be investigated by pyelography or ultrasound. In infants the anal canal must be carefully examined.
Septate vagina Sometimes the fusion of the two Mullerian ducts is incomplete, so that there is partial or complete duplication of the vagina, with an anteroposterior septum between the two passages. The uterus may also be duplicated. One vaginal passage may be larger than the other, and used for intercourse, or both may be equally developed. A vaginal septum may be completely missed on vaginal examination if the thin septum is displaced to one side and the other passage is not noticed. Sometimes a septum may obstruct delivery, but if it does not give way it can easily be divided.
Absent or rudimentary uterus
Complete absence of the uterus is very rare, but it may be rudimentary, when it is simply represented by a small thickening at the upper limit of the vagina. The endometrium is absent and there is amenorrhoea.
Failure of fusion of the Miillerian ducts
Failure of fusion of the two Mullerian tracts will give rise to varying degrees of duplication of the uterus and vagina, as shown in Fig. 8.2. There may be associated abnormalities of the ureters and kidneys.
Uterus didelphys
In this condition there is a complete lack of fusion of the Mullerian ducts, with a double uterus and double vagina.
Uterus bicomis bicollis
The two horns of the uterus remain completely separate as far as their cavities are concerned, although there is some fusion of the muscular walls, and the cervix is double. There mayor may not be a vaginal septum.
Uterus bicomis unicollis
The body of the uterus is bifid but the cervix is normally developed. The uterine horns may be unequal in size.
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