¹Rizkha Adistyatama, ² Nuring Pangastuti,

¹,²Department of Obstetrics and Gynaecology, Dr. Sardjito Hospital-Faculty of Medicine, Universitas Gadjah Mada, Indonesia 1 Kesehatan Street, Sekip, Sinduadi, Mlati, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55284, Indonesia

Background:

Development of female genital tract is a complex process and dependent upon a series of events involving cellular differentiation, migration, fusion, and canalization. Mullerian Duct Anomalies (MDA) are uncommon congenital anomalies, but can vary widely and treatable with surgical procedure. Classification system that have been used are classification from American Society for Reproductive Medicine (ASRM) and European Society of Human Reproduction and Embriology (ESHRE) and European Society for Gynaecological Endoscopy (ESGE). Surgical procedure in MDA patient had a high successful rate, but postoperative complication can arise in form of the need for further surgical requirement and acute kidney injury.

Case report:

A 20 year old girl admitted to obstetric gynecologic clinic with complaints of abdominal pain, amenorrhea, and redness voiding. She experienced abdominal pain since 6 years ago. Previously, patient had history of vaginal drainage procedure when she was 14 years old but she did not felt improvement in complaint and symptom. Cystoscopy and radiology imaging showed vaginal agenesis and renal dekstra agenesis, subsequently patient was planned for a sigmoid vaginoplasty procedure. Identification and exploration during surgery revealed vaginal agenesis, renal dekstra agenesis, hematometra from hemiuterus dekstra, hemiuterus sinistra with asesorius or hipoplasia uterine and hematosalping dekstra. In 5 days post operative, patient suffer anuria and acute kidney injury complication. Acute kidney injury after major surgery involving gastrointestinal was common because of surgical stress response, and agenesis renal condition aggravates this complication.

Mullerian Duct Anomalies, Anuria, Acute kidney injury, Sigmoid Vaginoplasty

1) Chandler TM, Machan LS, Cooperberg PL. Müllerian duct anomalies: from diagnosis to intervention. The British Journal of Radiology 2009; 82: 1034-1042

2) Dreisler E, Stampe Sørensen S. Müllerian duct anomalies diagnosed by saline contrast sonohysterography: prevalence in a general population. Fertil Steril 2014; 102(2):525–9.

3) Grimbizis GF, Campo R. Congenital malformations of the female genital tract: the need for a new classification system. Fertil Steril 2010; 94:401–407.

4) Spencer TE, Dunlap KA, Filant J. Comparative developmental biology of the uterus: insights into mechanisms and developmental disruption. Mol Cell Endocrinol 2012;354(1–2):34–53.

5) The American Fertility Society. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions. Fertil Steril 1988;49(6):944–55.

6) Grimbizis GF, Gordts S, Di Spiezio Sardo A, et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod 2013;28(8):2032–44.

7) Hendren WH, Atala A (1994) Use of bowel for vaginal reconstruction. J Urol 152:752–755

8) STARSurg Collaborative. Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study. BJS Open 2018; 2: 400-410.

9) Oppelt P, von Have M, Paulsen M, et al. Female genital malformations and their associated abnormalities. Fertil Steril 2007; 87(2):335–42.

10) Basturk T, Koc Z, Ucar T et al. Renal Damage Frequency in Patients with Solitary Kidney and Factors That Affect Progression. International Journal of Nephrology. 2015; 876907

11) Y.Wang, Z. Wang,W.Wang, H. Ren, W. Zhang, and N. Chen, “Analysis of factors associated with renal function in Chinese adults with congenital solitary kidney,” Internal Medicine, vol. 49, no. 20, pp. 2203–2209, 2010.

12) Choi M.B, Kim Jum, Seo Ji Hyoun, et al. Unilateral renal agenesis presenting with acute obstructive postrenal failure following administration of hydration fluid. Pediatrics International 2006: 48; 420-422

VOLUME 04 ISSUE 04 APRIL 2021