Congenital uterovaginal prolapse in a term neonate: a case report

Congenital uterovaginal prolapse in neonates is a rare condition, and it is often associated with spinal cord defects. A 3-day-old female term neonate born via cesarean section with a weight of 3.2 Kg was admitted to our pediatric surgery unit due to a protruding mass in the vaginal introitus and swelling in the lower back. On physical examination, the mass measured 4 by 5 cm was and appeared to be the vagina and part of the uterus. There was no discharge or bleeding. The mass was easily reducible but recurred when the patient cried. A spinal ultrasound confirmed a 3 by 2-cm defect in the lumbosacral area, consistent with a meningomyelocele. The patient also had bilateral clubfoot. A transfontanellar ultrasound showed obstructive hydrocephalus, likely due to aqueductal stenosis, and showed a small posterior fossa with an inferiorly displaced vermis, suggesting Chiari malformation type II. Several attempts at manual reduction and packing of the mass with a plaster were made but were unsuccessful. The patient was taken to the operating room for a vaginal cerclage. Two incisions were made on the vaginal wall at the 6 o'clock and 12 o'clock positions, approximately 1 cm above the fourchette. A circumferential suture of reabsorbable material was then placed and securely tied. The postoperative course was uneventful. The patient was subsequently transferred to the neurosurgery department for further evaluation and management. At three months of follow-up there have been no signs of tissue damage, and no recurrence of the prolapse . Congenital uterovaginal prolapse is a rare anomaly, and most cases occur in patients with neural tube defects. Vaginal cerclage seems to be a safe and effective management option.