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Mayer-Rokitansky-Küster-Hauser syndrome is a müllerian duct agenesis and occurs oncein 4,000 to 5,000 births. Approximately one third of cases are associated with renal anomalies, such as ectopic kidney, renal agenesis, horseshoe kidney, pelvic kidney, and bifid ureter or duplication. The typical clinical finding is partial or complete agenesis of the uterus, with an absence or hypoplasty of the vagina. Several methods have been proposed to compensate for congenital absence of the vagina in Mayer-Rokitansky-Küster-Hauser syndrome. 1,2 The authors have adopted a modification of the Ruge technique using the sigmoid colon (RugeHata method). 3 In the Ruge-Hata method, an inverted graft is sutured to the vaginal canal because of graft vascularization. Recently, Davydov's technique, 4 in which the peritoneum is pulled and sutured to the new vaginal cavity, has been introduced under laparoscopy. 5 In this case, the authors tried to perform minimally invasive surgery using laparoscopy for the purpose of satisfactory vaginal function and minimal complication. 6-8 (J GYNECOL SURG 17:97, 2001) CASE REPORTA 17-YEAR-OLD WOMAN WAS REFERRED FOR PRIMARY AMENORRHEA. She had normal secondary sexual characteristics in appearance but showed the absence of a vagina. Four years later, the patient desired the creation of a neovagina. She had normal external genitalia and pubic and axillary hair but no vagina, only a retrohymenal dimple approximately 3 cm in depth. We found a fibrous remnant tissue in the area of the uterus by rectal examination. Both ultrasound and magnetic resonance imaging showed uterine aplasia and bilateral ovaries with normal appearance. Chromosomal analysis showed a normal karyotype of 46XX. Drip infusion pyelography revealed a normal urinary tract. Radiographs and magnetic resonance imaging did not show skeletal abnormalities. At this point, Mayer-Rokitansky-Küster-Hauser syndrome was diagnosed. We made sure there were no abnormal lesions at the sigmoid colon by colonofiberscopy and barium enema. Angiography of the inferior mesenteric artery was performed to visualize the feeding arteries of the sigmoid colon. We tried to create a neovagina during laparoscopy by a modification of the Ruge technique. In this case, we intended to perform minimally invasive surgery using the laparoscopic technique for the purpose of satisfactory vaginal function and minimal complication.

We present a rare case of rupture of uterine pseudoaneurysm following laparoscopically assisted vaginal hysterectomy (LAVH). A 49-year-old gravida 4, para 4 experienced menorrhagia resulting in anemia. She was administered three doses of gonadotropin-releasing hormone agonists and subsequently underwent LAVH. She developed stomach ache on postoperative day 8, and abdominal computed tomography (CT) revealed hemoperitoneum. She was diagnosed with a ruptured pseudoaneurysm based on contrast-enhanced CT and underwent uterine artery embolization on the same day.Clinicians should consider pseudoaneurysm rupture leading to hemoperitoneum among the differential diagnosis in women presenting with profuse vaginal bleeding as the primary symptom.

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