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Title: Surgical management in a teenager with primary amenorrhea due to mullerian anomaly. Introduction: Congenital anomalies of the female reproductive tract may present with primary amenorrhea. Hereby presenting one such rare case of a 15 year old female with transverse vaginal septum with primary amenorrhea presenting with gross hematocolpus, hematometra and hematosalpinx. She had previously undergone surgical drainage vaginally with inadvertent injury to the rectum which was repaired in the same sitting. Aims and Objectives: to create a new pathway via abdominoperineal approach for drainage of hematometra and hematocolpos while keeping it patent for menstrual and sexual function in the future. Results: Patient underwent exploratory laparotomy for drainage of hematometra and simultaneous abdominoperineal approach was used to dissect through the transverse vaginal septum and keep the new pathway patent with mould created by plastic surgeons. Conclusion: Congenital anomalies often require a multidisciplinary approach, proper surgical management planning, and regular long-term follow-up.