Case Report Laparoscopic Colpo-Pneumo Occluder as a Vaginal Mold for Vaginal Reconstruction Alla Vash-Margita MD 1 , *, Levent Mutlu MD 2 , Oz Harmanli MD 3 1 Division of Pediatric and Adolescent Gynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut 2 Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut 3 Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut abstract Background: Currently, there is no commercially available soft vaginal mold designed for reconstructive surgeries for congenital vaginal anomalies. Stricter operating room regulations discourage the use of makeshift molds from foams and gloves. A colpo-pneumo-occluder balloon is designed to maintain pneumoperitoneum after colpotomy in laparoscopic hysterectomies and is approved for use in vaginal surgeries. Case: A 17-year-old girl with a congenital transverse vaginal septum experienced recurrent obstruction and hematocolpos. We successfully used a colpo-pneumo-occluder balloon as a vaginal mold during postoperative care. Its size and design make this device ideal for use in vaginal reconstructive surgeries in adolescents. Summary and Conclusion: The laparoscopic colpo-pneumo-occluder, a sterile vaginal device, is appropriate to use as an adjustable, soft vaginal mold for correction of congenital and acquired vaginal anomalies. Key Words: Vaginal septum, Vaginal mold, Adolescent, Colpo-pneumo-occluder Introduction Vaginal reconstruction requires a soft, space-occupying device, which is commonly referred to as vaginal mold, for management of vaginal anomalies, stenosis, and fore- shortening of the vagina. 1e5 In preparation for our surgery. we were not able to find a commercially available soft vaginal mold specifically designed for postsurgical man- agement of excision of transverse vaginal septum or neo- vagina in adolescent females. Stricter hospital regulations discourage surgeons from using makeshift molds from nonsterile foam, gloves and other materials, even when they are sterilized. Case A 17-year-old nulligravid female adolescent with a past medical history of Hashimoto's thyroiditis was referred to Pediatric and Adolescent Gynecology clinic for a second opinion due to cessation of menses and progressively worsening pelvic pain. She reported menarche at age 12 years and had monthly pain-free menstrual cycles until age 17 years 4 months, when her menstruation became irregular and eventually stopped. Patient had been amen- orrheic for 4 months at the time of evaluation. She had never been sexually active and denied a history of sexual abuse or any genital trauma. On physical examination, her height, weight, and body mass index were 157 cm (17.1 percentile), 47.9 kg (11.4 percentile), and 21.00 kg/m 2 (23.6 percentile), respectively. Her secondary sexual develop- ment was age-appropriate, with both breasts and pubic hair distribution at Tanner stage 5. Axillary hair was present. At presentation, she had mild suprapubic and lower abdom- inal tenderness. External visual inspection revealed normal labia majora and minora, normal external urethral meatus and clitoris, and an annular hymen. She declined digital or speculum pelvic examination because of fear and appre- hension related to a pelvic examination done prior to pre- sentation. Pelvic magnetic resonance imaging (MRI) demonstrated normal ovaries in size and position, arcuate uterus, hematocolpos measuring 53 Â 57 mm, and hema- tometra as well as a transverse vaginal septum approxi- mately 3.5 cm proximal to the introitus (Fig. 1). The uterine cavity was significantly dilated, as well as upper portion of the vagina. Renal ultrasound demonstrated orthotopically located normal bilateral kidneys. After a detailed review of these findings, the patient and her parent were consented for examination under anes- thesia and excision of the transverse vaginal septum with possibility of grafting. Intraoperative examination revealed a transverse vaginal septum without fenestration located 3.5 cm proximally from the introitus and approximately 1 cm in thickness. Resection of the septum was accom- plished by making a stab incision through the septum at the lowest portion of blood collection under the ultrasound guidance. After evacuation of 500 mL of hematocolpos, The authors declare no conflict of interests in regard to this work. There was no funding for this study. * Address correspondence to: Alla Vash-Margita, MD, Division of Division of Pe- diatric and Adolescent Gynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, 310 Cedar Street, FMB 329B, New Haven, CT 06510. Phone: (203) 785-4010; fax: (203) 785-7675 E-mail address: alla.vash-margita@yale.edu (A. Vash-Margita). 1083-3188/$ - see front matter Ó 2020 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. https://doi.org/10.1016/j.jpag.2020.08.002