Uterine Isthmus Atresia Conservatively Treated by Laparoscopy and Transvaginal Utero-Cervical Anastomosis

Uterine Isthmus Atresia (UIA) is an unusual complete separation of uterine body from cervix, often excessively treated (hysterectomy). This report aims to describe a uterine-sparing technique for UIA treatment. This is the case of a 14-year-old girl referred for primary amenorrhea and cyclic pelvic pain. Imaging study was suggestive for UIA, hematometra and bilateral hematosalpinx. The patient was submitted to a combined laparoscopic-transvaginal end-to-end utero-cervical anastomosis. A stable anastomosis was obtained. At 3-month follow up the patient referred regular painless menses. Ultrasound identified the new connection between the cervix and the uterine body. Hysteroscopy revealed a short but regular cervical canal, widely permeable and regularly connected with the uterine cavity. For UIA treatment, when the cervical segment is intact, an end-to-end utero-cervical anastomosis is feasible and effective.