Presented are two cases of imperforate hymen with hematocolpos seen in a pediatric emergency department (ED) during a seven-month period. The first case presented with abdominal pain, urinary obstruction, and constipation on initial visit. [ncbi.nlm.nih.gov]

Our patient had a history of irregular periods since her menarche 9 months before presentation, as well as a history of daily bleeding for 3 months. This presentation initially did not lead to the consideration of a diagnosis of hematocolpos. [consultant360.com]

Ideally, diagnosis should be made early during fetal and neonatal examinations to prevent symptomatic presentations of its complications at puberty. [omicsonline.org]

We present the case of an 11-year-old girl who presented as a surgical emergency with acute abdominal pain. [sciencerepository.org]

• Intermittent Fever

  She also had had intermittent fever as high as 38.9°C. There was no history of vomiting, diarrhea, or constipation. Her last menstrual period had lasted for 3 months and had ended 3 days before presentation. [consultant360.com]

• Perineal Pain

  Hematocolpos should be on the list of differential diagnoses in adolescent girls with primary amenorrhea who present with any of the following: cyclic recurrent abdominal pain; persistent lower abdominal and back pain; perineal pain and pressure; symptoms [consultant360.com]

• Splenomegaly

  Results of abdominal ultrasonography were normal except for mild splenomegaly. [consultant360.com]

• Abdominal Tenderness

  The embryogenesis of müllerian duct abnormalities, associated clinical findings, including abdominal tenderness and pelvic mass, diagnostic modalities of cystoscopy, excretory urography, laparoscopy and hysterosalpinography are discussed. [ncbi.nlm.nih.gov]

• Costovertebral Angle Tenderness

  She had no costovertebral angle tenderness. Laboratory tests revealed a white blood cell (WBC) count of 6,800/µL, a hemoglobin level of 11.3 g/dL, and a platelet count of 298 × 10 3 /µL. [consultant360.com]

• Waddling Gait

  Our patient complained of severe perineal and vaginal pain related to pressure from the mass, to the extent that she was having trouble sitting and had a waddling gait. [consultant360.com]

• Imperforate Hymen

  Most common cause of hematocolpos (LQ) A cervical atresia B vaginal atresia C transverse vaginal septum D imperforate hymen Ans. D imperforate hymen I. Hematocolpos is collection of blood in the vagina. II. [gradestack.com]

  hymen: An imperforate hymen is a medical condition where the girls are born with a hymen which covers the whole opening of the vagina. [en.wikipedia.org]

  Surgery is always indicated when imperforate hymen becomes symptomatic we report the case of an imperforate hymen who presented late with delayed menarche, massive hematocolpos and hematometra. [omicsonline.org]

  A genitourinary exam revealed an imperforate hymen. A diagnosis of hematocolpos secondary to imperforate hymen was made and surgically confirmed. [doi.org]

• Amenorrhea

  Hypothalamic amenorrhea is typically characterized by amenorrhea in the absence of anatomic, chromosomal or organic abnormalities. Often a diagnosis of exclusion, it is one of the most common causes of secondary amenorrhea [7]. [file.scirp.org]

  The most common cause of hematocolpos is an imperforate hymen, which is associated with primary amenorrhea. Primary amenorrhea also is present when hematocolpos is caused by a complete transverse vaginal septum, vaginal agenesis, or vaginal atresia. [consultant360.com]

  While unusual, this case demonstrates that hematocolpos should be considered in patients with a history of epidermal bullous disease and amenorrhea. [ncbi.nlm.nih.gov]

  Keywords : hematocolpos; imperforate hymen; primary amenorrhea. [scielo.mec.pt]

• Primary Amenorrhea

  Keywords : hematocolpos; imperforate hymen; primary amenorrhea. [scielo.mec.pt]

  Saks, E.K., Vakili, B. and Steinberg, A.C. (2009) Primary amenorrhea with an abdominal mass at the umbilicus. [file.scirp.org]

  The most common cause of hematocolpos is an imperforate hymen, which is associated with primary amenorrhea. Primary amenorrhea also is present when hematocolpos is caused by a complete transverse vaginal septum, vaginal agenesis, or vaginal atresia. [consultant360.com]

• Delayed Menarche

  The diagnosis is usually delayed till after puberty when it presents with its complications like delayed menarche, cyclic lower abdominal pain and mass, and bulging vaginal membrane as in miss UG [ 2 ]. [omicsonline.org]

  menarche often Hematometra is a related condition in which the uterus fills with menstrual blood. [nursespost.com]

• Enlarged Uterus

  Transabdominal POCUS showed a distended vaginal canal, markedly enlarged uterus, and moderate hydronephrosis bilaterally (Video). Renal function was normal on a chemistry panel. She was diagnosed with hematometrocolpos, and gynecology was consulted. [westjem.com]

  With ultrasound the uterus can be seen as an enlarged pelvic mass with an echo free lumen due to the presence of blood [14]. [medcraveonline.com]

A previously healthy 12-year-old female was sent to the Emergency Department by her pediatrician for workup of severe suprapubic abdominal pain radiating to her lower back. [doi.org]

International Journal of Emergency Medicine volume 3, pages 481 – 482 ( 2010 ) | Download Citation A previously healthy 12-year-old female was sent to the Emergency Department by her pediatrician for workup of severe suprapubic abdominal pain radiating [intjem.biomedcentral.com]

Discussion Early diagnosis and timed surgical treatment of an imperforate hymen are important to prevent the complications associated with the delayed treatment after puberty. [omicsonline.org]

This also results in infertility.[16] Treatment[edit] As the causes for Hematocolpos are diverse, there are different surgical treatments which needs to be undertaken to cure it. [en.wikipedia.org]

Even when the condition is properly diagnosed, the results of treatment are often unsatisfactory. In the University Hospital one death followed treatment. [doi.org]

All patients underwent vaginal conservative surgical treatment (excision of vaginal septum) +/- radical treatment: hemi- colpohysterectomy in case of failure of conservative treatment. [ncbi.nlm.nih.gov]

Outcome and Prognosis Clinical outcome and prognosis generally are good; one study found pregnancy success more likely following surgical correction of an imperforate hymen than following repair of a complete transverse septum. [33] The retrograde menses [emedicine.medscape.com]

Patient and her parents were counseled about poor prognosis in view of cervical stenosis and were asked to follow up as the definitive plan in this case was hysterectomy. [jpgo.org]

Synonyms/Description Hydrometra and hydrocolpos Pyometra and pyocolpos Etiology The most common etiology is cervical or vaginal obstruction, resulting in a collection of blood, pus, or fluid that distends the uterus or vagina. [clinicalgate.com]

On evaluation, the goal is to differentiate an imperforate hymen from other obstructing anatomic etiologies, such as labial adhesions, urogenital sinus, transverse vaginal septum, or distal vaginal atresia. [m.acog.org]

Spectrum of etiologies causing hydrometrocolpos. J Neonatal Surg 2013; 2(1): 5. Google Scholar | Medline 12. Garcia Rodriguez, R, Perez Gonzalez, J, Garcia Delgado, R. [journals.sagepub.com]

Clinicians must be aware of atypical presentations and potential multifactorial etiologies of amenorrhea. Ensuring a thorough evaluation is essential in order to mitigate long-term effects of a misdiagnosis. [file.scirp.org]

Pathophysiology The cause of Hematocolpos can vary, but almost exclusively involves physical obstruction of the reproductive tract, leading to a backup of menstrual blood which accumulates proximal to the obstruction. [nursespost.com]

Golden, N.H. and Carlson, J.L. (2008) The pathophysiology of amenorrhea in the adolescent. [file.scirp.org]

^ "Vaginal Atresia: Background, Anatomy, Pathophysiology". 2019-07-03. ^ "Transverse Vaginal Septum | Boston Children's Hospital". www.childrenshospital.org. [en.wikipedia.org]

Ideally, diagnosis should be made early during fetal and neonatal examinations to prevent symptomatic presentations of its complications at puberty. [omicsonline.org]

This fatality led to a review of the subject in the hope that another such occurrence might be prevented. [doi.org]

Findings concerning a genital tract outflow obstruction in a young female are generally treated without delay to prevent future reproductive problems. [ncbi.nlm.nih.gov]