Rotated hypoplastic hemipelvis: a cause of obstructive dyspareunia

Area of Science:

• Orthopedic Surgery
• Gynecologic Surgery
• Reconstructive Surgery

Background:

• Pelvic osteotomies, such as the Chiari innominate osteotomy, are complex procedures.
• Traumatic injuries can lead to significant pelvic and lower limb deformities, including hemipelvis and leg hypoplasia.
• Post-surgical complications can arise, impacting adjacent anatomical structures and patient quality of life.

Observation:

• A young woman with a history of traumatic monoplegia underwent a repeat Chiari innominate osteotomy.
• The osteotomy resulted in the pubic ramus rotating into the vaginal canal.
• This anatomical repositioning caused obstructive dyspareunia, significantly impairing sexual function.

Findings:

• Surgical intervention was required to address the complication of pubic ramus malposition.
• A transperineal approach was utilized for the resection of the inferior pubic ramus.
• This targeted resection successfully corrected the anatomical obstruction.

Implications:

• This case highlights a rare but significant complication following repeat pelvic osteotomy.
• Transperineal pubic ramus resection offers a viable solution for managing obstructive dyspareunia secondary to pelvic surgery.
• Successful surgical management restored sexual function and improved the patient's quality of life.