Presentation
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]
We present the case of an 11-year-old girl who presented as a surgical emergency with acute abdominal pain. [sciencerepository.org]
We present the case of a14-year-old female patient who presented to the emergency department with amenorrhea andabdominal pain, and was found to have an imperforate hymen and hematometrocolpos on transabdominalpoint-of-care ultrasound. [doi.org]
The classic presentation of hematometrocolpos is a pubescent female who presents with episodic, cramping lower abdominal and pelvic pain. [westjem.com]
Although rare, it can also present during the neonatal period owing to mucocolpos [12]. [chikd.org]
Entire Body System
- Pain
Irritation of the sacral plexus or nerve roots is postulated as a mechanism for the referred back pain. Hematocolpos should be included in the differential diagnosis of prepubertal girls who have low back pain. [ncbi.nlm.nih.gov]
If not screened for and treated early, patients present at menarche with a history of cyclical pelvic or abdominal pain and urinary retention due to hematocolpos. [doi.org]
It is associated with acute or chronic pain in the abdomen or pelvic pain along with other reproductive problems. A significant share of the women with cervical atresia have it since birth, that is, they congenital cervical atresia. [wikizero.com]
- Surgical Procedure
Early accurate diagnosis and treatment will decrease morbidity and unnecessary surgical procedures. [ncbi.nlm.nih.gov]
See actual surgical procedures and realistic depictions of surgical geography thanks to color photographs of surgeries and pelvic cadaver anatomy. [books.google.ro]
Postoperative details: The surgical procedure of hymenotomy and evacuation of hematocolpos is performed on an outpatient basis. [doctorslounge.com]
Comprehensive coverage of conventional and endoscopic surgeries helps you master the full spectrum of surgical procedures. Expert Consult eBook version included with purchase. [books.google.com]
- Anorexia
腹部膨満 abortion流産 adenomyosis子宮腺筋症 adnexectomy付属器摘出術 adnexitis子宮付属器炎 amenorrhea無月経 amniocentesis羊水穿刺 amnioreduction羊水除去 amniotic fluid羊水 amniotic fluid embolism (amniotic embolus)羊水塞栓 anamnesis病歴、既往歴 androgen insensitivity syndrome精巣女性化症候群 anemic貧血[性]の anorexia [tokyo-med.ac.jp]
Gastrointestinal
- Abdominal Pain
The first case presented with abdominal pain, urinary obstruction, and constipation on initial visit. The diagnosis was not made on the initial presentation. [ncbi.nlm.nih.gov]
If not screened for and treated early, patients present at menarche with a history of cyclical pelvic or abdominal pain and urinary retention due to hematocolpos. [doi.org]
Case report: A previously healthy almost 14-year-old girl, was admitted to the emergency department with lower abdominal pain and acute urinary retention. No previous menstruation. [scielo.mec.pt]
- Constipation
The first case presented with abdominal pain, urinary obstruction, and constipation on initial visit. The diagnosis was not made on the initial presentation. [ncbi.nlm.nih.gov]
The mass effect caused by the hematocolpos was likely the cause of the patient's constipation - which was the sole presenting complaint. 1 article features images from this case [radiopaedia.org]
The patient additionally reported symptoms of increased urinary frequency and urgency in addition to constipation. On review, she denied fever, abnormal vaginal discharge, or perceived change in menstrual flow. [anatomybox.com]
Our patient also had occasional constipation and retention of urine. [omicsonline.org]
- Abdominal Distension
Objective examination with pubertal Tanner stage IV, abdominal distension and pelvic mass. Gynecological examination revealed a blue imperforate hymen bulging from the vagina introitus outwards. [scielo.mec.pt]
She reported progressively increasing lower abdominal distension, with pain as well as discomfort over the prior two months, which was cyclically associated with the onset of menses. [anatomybox.com]
Musculoskeletal
- Back Pain
Irritation of the sacral plexus or nerve roots is postulated as a mechanism for the referred back pain. Hematocolpos should be included in the differential diagnosis of prepubertal girls who have low back pain. [ncbi.nlm.nih.gov]
Irritation of the sacral plexus or nerve roots is postulated as a mechanism for the referred back pain. Hematocolpos should be included in the differential diagnosis of prepubertal girls who have low back pain. © Lippincott-Raven Publishers. [journals.lww.com]
DISCUSSION Girls with UTI typically present with fever, abdominal pain, and low back pain, along with urinary urgency, frequency, dysuria, and difficulty with voiding. [consultant360.com]
Hematocolpometra due to an imperforate hymen presenting with back pain: sonographic diagnosis. J Ultrasound Med. 2010;29(2):321-2. 4. Lollgen RM, Sabo J, Mettler A, et al. [westjem.com]
- Osteoporosis
In this patient, recognizing some features of the “female athlete triad:” low energy availability, amenorrhea, and osteoporosis, helped establish hypothalamic dysfunction as a possible secondary diagnosis [11]. [file.scirp.org]
Neurologic
- Sciatica
To document the occurrence of hematocolpos causing sciatica and leg weakness in an adolescent girl. Low back pain resulting from hematocolpos has been reported previously but not associated with symptoms of sciatica or neurologic weakness. [ncbi.nlm.nih.gov]
An unusual cause of sciatica in an adolescent girl. Spine 1996; 21: 1381-2. Little HK, Crawford DB, Meister K. Hematocolpos diagnosis made by ultrasound.JCU (J Clin Ultrasound) 1978; 6: 341-2. Van Bommel PJ, Abdullo O. [journalijar.com]
Urogenital
- 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]
A genitourinary exam revealed an imperforate hymen. A diagnosis of hematocolpos secondary to imperforate hymen was made and surgically confirmed. [doi.org]
As the surgical outcome after adequate hymenotomy for imperforate hymen is usually good, the diagnosis of imperforate hymen is important. [chikd.org]
Ultrasound and subsequent surgery confirmed the physical findings in the ED of imperforate hymen and hematocolpos. Both patients underwent hymenectomy, and they have experienced no further symptoms. [ncbi.nlm.nih.gov]
- Urinary Retention
TY - JOUR T1 - [Acute urinary retention secondary to an imperforate hymen with hematocolpos]. [wwww.unboundmedicine.com]
Acute Urinary Retention by Hematocolpos in an Adolescent Girl with Imperforate Hymen: A Case Report Abstract Mechanical obstruction by hematocolpos can result in acute urinary retention. [synergypublishers.com]
- Amenorrhea
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]
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]
- Primary Amenorrhea
Keywords : hematocolpos; imperforate hymen; primary amenorrhea. [scielo.mec.pt]
The imperforate hymen is the simplest defect that results in primary amenorrhea. It may be associated with cyclic pelvic pain and a mass kidnapping perirectal with blood in vagina (hematocolpos). [medigraphic.com]
Saks, E.K., Vakili, B. and Steinberg, A.C. (2009) Primary amenorrhea with an abdominal mass at the umbilicus. [file.scirp.org]
- Dyspareunia
Cervical stenosis ) · Cervical dysplasia General Hematometra · Retroverted uterus Vagina Vaginitis ( Bacterial vaginosis, Atrophic vaginitis, Candidal vulvovaginitis ) · Leukorrhea / Vaginal discharge · Hematocolpos / Hydrocolpos Sexual dysfunction ( Dyspareunia [wiki30.com]
Orphanet Frequency HPO Source Accession 1 fever 59 32 hallmark (90%) Very frequent (99-80%) HP:0001945 2 premature birth 59 32 hallmark (90%) Very frequent (99-80%) HP:0001622 3 breech presentation 59 32 hallmark (90%) Very frequent (99-80%) HP:0001623 4 dyspareunia [malacards.org]
If the septum is partial, it may be discovered on a routine gynecologic examination, or the patient may present with dyspareunia. The operation is performed to remove the transverse vaginal septum without significantly shortening the vaginal canal. [atlasofpelvicsurgery.com]
Although the surgical outcome after adequate hymenotomy for imperforate hymen is usually good, close follow-up is still necessary because some patients experience recurrence or symptoms such as dyspareunia, abnormal menstruation, or persistent problems [chikd.org]
Workup
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]
2010 International Journal of Emergency Medicine volume 3, pages 481–482 (2010)Cite this article 2470 Accesses 7 Citations 17 Altmetric Metrics details A previously healthy 12-year-old female was sent to the Emergency Department by her pediatrician for workup [intjem.biomedcentral.com]
Treatment
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]
"THE TREATMENT OF IMPERFORATE HYMEN WITH HEMATOCOLPOS". Journal of the American Medical Association. 113 (10): 913–916. doi : 10.1001/jama.1939.02800350023007. ^ Smith, Roger Perry (2008-01-01). Netter's Obstetrics and Gynecology. [thereaderwiki.com]
However, this patient developed an obstruction due to lack of prophylactic treatment. [primescholars.com]
Prognosis
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. [34] The retrograde menses [emedicine.medscape.com]
On the other hand, its lack of knowledge exposes it to serious complications, threatening its vital prognosis and seriously compromising its obstetrical future. [peertechzpublications.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]
Etiology
Hematometra and Hematocolpos 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]
DOI: https://doi.org/10.20344/amp.11912 Keywords: Adolescent, Hematocolpos, Hymen, Urinary Retention/etiology Abstract Hematocolpos is an obstruction of the menstrual flow due to an anomaly of the genital tract, with imperforate hymen being the most common [actamedicaportuguesa.com]
Methods: A thirteen weeks pregnant complaining severe pelvic pain was evaluated for etiology. [jcog.com.tr]
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]
Epidemiology
Journal Journal ID (nlm-ta): Pan Afr Med J Journal ID (iso-abbrev): Pan Afr Med J Journal ID (publisher-id): PAMJ Title: The Pan African Medical Journal Publisher: The African Field Epidemiology Network ISSN (Electronic): 1937-8688 Publication date (Electronic [scienceopen.com]
Pathophysiology
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. [wikizero.com]
^ "Vaginal Atresia: Background, Anatomy, Pathophysiology". 2019-07-03. ^ "Transverse Vaginal Septum | Boston Children's Hospital". www.childrenshospital.org. Retrieved 2019-09-21. External links[edit] [en.wikipedia.org]
Prevention
After surgical evaluation and drainage of hematocolpos via incision and drainage, a foley balloon was placed to prevent re-epithelialization. Intra-operative fluid cultures yielded no growth. [primescholars.com]
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]