The Müllerian or paramesonephric ducts are the primordia of the female reproductive tract (FRT). Their development and differentiation give rise to the fallopian tubes, uterus, cervix, and the upper vagina. Properly developed FRT plays an important role in promoting successful process of fertilization and pregnancy.

Background: Globally, the incidence of cervicalagenesis is estimated at 0.01% and constitutes 3% of
all Müllerian anomalies.
Case presentation: A 17-year-old nulliparous presented to the gynecology clinic with a transverse
vaginal septum and cyclic lower abdominal pain after two failed vaginal surgical procedures to restore genital tract patency. The examination under anesthesia revealed a 3cm short vagina, and a decision was made for vaginoplasty. Magnetic resonance imaging of the pelvis revealed a bulky uterus. Intraoperatively, locating the cervix through
the neo-vagina was difficult, and laparotomy was opted for. The left adnexa and cervix were absent, with an atrophic right ovary and a hydrosalpinx on the fallopian tube. Creating a uterovaginal anastomosis was difficult as the uterus was high in the pelvis. Postoperatively, the patient was counseled, and hysterectomy and right oophorectomy were done four months later.
Conclusion: Vaginoplasty with total hysterectomy is an alternative management method in failed uterovaginal anastomosis.
Keywords: cervical agenesis, hysterectomy, uterovaginal anastomosis, vaginoplasty

Background: There exists an unmet need for timely initiation of reliable postpartum contraception among mothers. This could result in unplanned and closely spaced pregnancies that may endanger the lives of the mother and the unborn baby.
Case presentation: A 22-year-old para 1+0 presented to the emergency department with gradual onset of lower abdominal pains, per vaginal spotting, and bloating 10 weeks after childbirth. She reported fulltime breastfeeding and regular and consistent use of male condoms for contraception. A diagnosis of ectopic pregnancy was established following a positive urine pregnancy test and a transabdominal ultrasound that revealed features of right tubal pregnancy. Exploratory laparotomy and partial salpingectomy were performed. The patient was stable and was discharged on the second postoperative day.
Conclusion: Early return of fertility in exclusively breastfeeding mothers is possible; hence, an effective family planning method is needed during the postpartum period to minimize the complications of short interpregnancy intervals.
Keywords: breastfeeding, early return of fertility, ectopic pregnancy, postpartum contraception

Background: Uterine leiomyomas are the most typical benign pelvic neoplasms in women. Giant leiomyomas are very rare and present diagnostic and management challenges.
Case presentation: A 50-year-old presented to the gynecology clinic with abdominal distension associated with mild lower abdominal pain, which had progressively worsened for five years. She reported no history of vaginal discharge or abnormal uterine bleeding. On examination, she had a grossly distended abdomen with a firm, nontender pelvic mass extending to the xiphisternum. An ultrasound scan revealed a giant leiomyoma. She underwent a multidisciplinary total abdominal hysterectomy, which was complicated by a bladder injury. She recovered well postoperatively with a resolution of her symptoms.
Conclusion: Surgery for giant uterine leiomyomas can be challenging and requires careful surgical preparation with appropriate imaging and uterine artery embolization where available. Anticipation of complications and multidisciplinary team management are critical.
Keywords: giant leiomyoma, postmenopausal, total hysterectomy

Background: High-grade endometrial stromal sarcoma (HG-ESS) is a homologous uterine sarcoma of a mesenchymal origin. Its natural course is poorly understood, making preoperative diagnosis difficult.
Case presentation: A 55-year-old nulliparous presented to the gynecological oncology ward as a referral with progressive abdominal distension and pain, constipation, and postprandial vomiting. Computed tomography (CT) scan of the abdomen revealed a bulky uterus with multiple calcified masses with cystic degeneration. A chest CT scan revealed bilateral upper and lower lobe nodules with mediastinum and hilar adenopathy. She was scheduled for total abdominal hysterectomy and bilateral salpingo-oophorectomy. A histopathological examination confirmed HG-ESS. The patient survived for three months following surgery.
Conclusion: HG-ESS is rare. This case highlights the nonspecific presentation, aggressive nature of the tumor, rapid progression of the disease, and the challenges clinicians face in managing patients who do not honor their appointments with resultant poor overall survival in the late stage.
Keywords: HG-ESS, uterine sarcoma

Background: Retained foreign objects (RFOs) are surgical items that are unintentionally retained within the patient's body after a surgical procedure and are associated with morbidity, mortality and medicolegal ramifications.
Case presentation: A 48-year-old para 3+0 presented to the gynecology clinic with a long-standing history of nonspecific symptoms following hysterectomy performed 22 months earlier. Examination findings and imaging studies were unremarkable. Diagnostic laparoscopy revealed a retained retractor blade overlying the sigmoid colon. The symptoms resolved after removal, and the patient was discharged on the second postoperative day.
Conclusion: Retained foreign objects often result in nonspecific symptoms and may be missed on imaging leading to diagnostic challenges. A high suspicion index is required to diagnose RFOs.
Keywords: chronic pelvic pain, hysterectomy, laparoscopy , retained foreign objects