Primary vaginal calculi

Case contributed by Dr Subahshini Jeyabalan

Presentation

History of cloacal anomaly and uterine didelphys with hydrocolpos, Post Posterior Sagittal Anorectal Vaginal Urethral Plasty (PSARVUP) complicated with vaginal stricture, urethral stricture and vesicovaginal fistula. Presented with suprapubic pain for one week.

Patient Data

Age: 5 years
Gender: Female
mri

Incomplete longitudinal T2 hypointense septum dividing the vagina into two hemivaginas with grossly dilated vaginal canal in keeping with hydrocolpos. 

Multiple large vaginal calculi are seen within the hydrocolpos.

Urinary bladder cavity is small with irregular contour. A tract is seen communicating the posterior bladder wall with anterior aspect of the left hemivagina likely to represent vesicovaginal fistula.

At each anterolateral aspect of the hemivaginas, there is T2 hyperintense tubular channel in keeping with cervix with two uterus consistent with uterine didelphys.

The course of vaginal canal distally to the perineum is not demonstrable.

Delineation of the urethral tract from the urinary bladder to the perineum is not appreciated.

Case Discussion

This case demonstrates vesicovaginal fistula, vaginal and urethral stricture that encourage urinary stasis with consequent formation of the primary vaginal calculi in the distended fluid-filled vagina (hydrocolpos).

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