Double mucosal flap for the reconstruction of transverse vaginal septum – A novel surgical approach using the vaginal septal tissue

Transverse vaginal septum is a congenital anomaly typically undiagnosed until menarche. Although the majority of such septa occur at the junction of the middle and upper thirds of the vagina, transverse vaginal septummay be found at any vaginal level (Fig.1). A complete transverse septum will block menstrual flow and is a cause of primary amenorrhea and hematocolpus accompaniedwith cyclic abdominal pain, tubo-ovarian abscess, urinary tract infection and endometriosis. Some transverse septa are incomplete and may cause dyspareunia or obstruction in labor.1 Transperineal, transrectal, and abdominal ultrasonography will show distended upper vagina and may be beneficial in establishing the diagnosis and for determination of the location and thickness of a transverse vaginal septum. MRI is the gold standard for a precise diagnosis of the anomaly, determination of the depth of the vagina, identification of the thickness of the septum and the extent of the distension of the vagina, cervix, and uterus or tubes.2 Common surgical technique used to repair transverse septum is resection followed by primary end-to-end anastomosis of the lower