Cervical Agenesis and Compressive Hydronephrosis in a Patient With Limited English Proficiency

Cervical agenesis is an extremely rare congenital anomaly of the female reproductive tract characterized by normal fallopian tubes, an absent cervix, a functioning uterine body, and, occasionally, partial or total vaginal aplasia. It often presents with primary amenorrhea and cyclic pelvic pain. Delayed diagnosis can lead to severe morbidity from retrograde menstruation, including hematometra, hematosalpinx, and endometriosis. Patients with limited English proficiency (LEP), particularly Haitian women, face compounded systemic hurdles when navigating the healthcare system, significantly increasing the risk of nonattendance at follow-up appointments. A 27-year-old Haitian Creole-speaking nulligravida woman with LEP presented with a multi-year history of worsening cyclic pelvic pain and primary amenorrhea. Over 951 days, she sought care 16 times across multiple EDs, imaging centers, and healthcare clinics. Despite the consistent presence of a medical interpreter and repeated cross-referrals, the patient successfully attended only three general gynecology clinic visits and did not complete the necessary reproductive endocrinology subspecialty appointments, highlighting a breakdown in both follow-up and systemic tracking mechanisms. Diagnostic imaging eventually revealed severe hematometra, bilateral hematosalpinx, and large pelvic endometriomas. The untreated, chronic retrograde menstruation led to mass-effect compression of the left ureter, causing rapidly progressive unilateral hydronephrosis. Without treatment, cervical agenesis with a functioning endometrium can cause profound anatomical distortion and secondary urological complications. This case underscores the danger of relying on passive referral systems for vulnerable LEP patient populations. LEP is one of several contributing factors in delayed care and highlights the critical need for active, language-concordant patient navigation to prevent catastrophic breakdowns in continuity of care. Patient participation in the referral process is critical.