Figure 4. (Case 4). (A) MRI findings (T2-weighted imaging, axial plane): Duplicated uterus was observed. (B) MRI, sagittal plane: A hemorrhagic cyst was observed in the uterine cervix of the affected side. (C) Schematic representation of the genital organs seen in Case 4. (D) Exploratory puncture was performed at the site where the uterine cervical cyst was expected, and indigo carmine was injected. (E) Pigment outflow was laparoscopically observed from the left tubal fimbriae, thereby confirming that the puncture site had entered the uterine cavity of the affected side. (F) Spreading of the puncture site with a scalpel. (G) Insertion of a large Nelaton catheter to prevent restenosis. (H) Histology of the fenestrated vaginal wall, composed of stratified squamous epithelium.