An overlooked cause of acute urinary retention in an adolescent girl: a case report

Hymen-saving hymenotomy of imperforate hymen in neonates and adolescents: tertiary medical center experience

Background

Imperforate hymen (IH) is the most common obstructive anomaly of female genital tract. Hymen saving has a great importance for both cultural and religious reasons. Conventional surgical treatment for this condition is cruciate incision hymenotomy or hymen-saving central annular hymenotomy (HSCAH). This study aimed to review presentations and management of neonate and adolescents with IH at one tertiary hospital over 12 year’s period. The aim also was to stress upon importance of hymen saving to our Muslim community and improve knowledge, enable targeted education, and reduce unnecessary tests and diagnostic delay for this condition.

Methods

Twenty-five patients with IH were diagnosed and treated in this retrospective cohort study over 12 years, from January 2010 till December 2021. Demographic characteristics of the patients, their symptoms and signs, investigations, type of operations, recurrence, and infections were recorded and analyzed.

Results

Saudi accounted for the majority of IH cases (88%). There were fifteen adolescents, and ten were neonates. Bulging imperforate hymen, pelvic/abdominopelvic mass, constipation, acute urine retention, abdominal discomfort, and lower abdominal distension were among the signs and symptoms. All 25 patients had HSCAH, 21 of whom had primary HSCAH and four of whom had secondary HSCAH due to recurrence. To avoid recurrence, HSCAH was performed with suturing of the inner vaginal mucosa to the exterior vestibular mucosa.

Conclusion

Early diagnosis of imperforate hymen for neonate and adolescent girls and prompt definitive HSCAH could have positive impact on treatment outcome and decrease complications and fulfill integrity of hymen as virginity of high importance in our Muslim community and other similar culture, where hymen-sparing procedure is preferred by most of these patients and families.

A Retrospective Study on Imperforate Hymen and Haematometrocolpos in a Regional Hospital

Objective

To find out the characteristics and presentations of imperforate hymen in the local population in Hong Kong and to assess if diagnosis of imperforate hymen made in the emergency department can reduce time to operation and length of hospital stay.

Design

Retrospective study.

Setting

A regional public hospital in Hong Kong.

Patients

We retrospectively collected data of all patients with the diagnosis of imperforate hymen (ICD 9 coding 752.42) from the period of January 1999 to June 2009. Demographics of the patients, their presenting symptoms and signs, the diagnostic process, investigation findings and time of operation were recorded and analysed.

Results

Fifteen cases of imperforate hymen were reported during that period. All were adolescent girls aged from 10 to 15 years. A total of 13 patients presented to the accident and emergency department (AED). Seven patients had the diagnosis made in the AED and 2 patients received bedside pelvic ultrasound. More than half of them (8 patients) presented with acute retention of urine. Other presentations included lower abdominal pain, constipation, lower abdominal mass, and protruding introital mass. Most cases diagnosed in the AED (5 out of 7) were admitted to the gynaecology ward while the others were admitted to the surgical or urology wards. Five out of the 7 cases diagnosed in the AED received operation within 24 hours; whereas only 1 out of the 6 cases with the diagnosis made after admission had operation within 24 hours. The difference was statistically significant (p=0.035, Fisher's exact test). The mean length of stay of the group diagnosed in the AED was 1.9 days while the mean length of stay for the group diagnosed after admission was 4.2 days.

Conclusion

Early diagnosis of imperforate hymen and haematometrocolpos in the AED for adolescent girls with primary amenorrhoea could have positive impact on proper admission to the gynaecology ward, prompt operation and shorter length of stay in hospital.

Spontaneous Reformation of Imperforate Hymen after Repeated Hymenectomy

BACKGROUND

Imperforate hymen prevents menstrual blood drainage, which causes cyclic lower abdominal pain and amenorrhea. Untreated patients might develop serious complications such as endometriosis and infertility. Hymenectomy represents the adequate treatment.

CASE

In a 16-year-old female virgin presented with recurrent lower abdominal pain, urine retention, and secondary amenorrhea after 3 hymenectomy surgeries. The examination revealed imperforate hymen. A fourth hymenectomy was performed with continuous locked sutures over all of the edges.

SUMMARY AND CONCLUSION

Recurrent imperforate hymen after hymenectomy should be suspected if symptoms recur. Diagnosis can be achieved through meticulous clinical examination and appropriate imaging techniques.

Virginity sparing surgery for imperforate hymen: report of two cases and review of literature

Imperforate Hymen (IH), an obstructive congenital anomaly of the female genital tract, is seen in 1 in 2000 female births. Treatment of IH is hymenotomy or hymenectomy. Different types of incisions are mentioned in the literature. We reported two cases of IH with different clinical presentations and described a simple virginity preserving and socially acceptable procedure to protect the virginity of the patient. In cultures and religions where the destruction of the hymen is a social problem in unmarried girls, virginity sparing surgery should be chosen in gynecological practice. Here we described a simple procedure without need for prophylactic antibiotic treatment and foley catheter application to form an intact annular hymen in two cases.

Magnetic resonance as an aid in the diagnosis of a transverse vaginal septum

Transverse vaginal septum is a rare, often overlooked congenital abnormality that is typically not diagnosed until adolescence. We present the case of a transverse vaginal septum and partial bicornuate uterus in a 16-year-old adolescent girl with developmental delay and cerebral palsy. Magnetic resonance is an excellent diagnostic tool to delineate the specific anatomy before surgery. The effects of delayed diagnosis and the utility of magnetic resonance in diagnosis will be discussed.

Spontaneous rupture of the imperforate hymen in an adolescent girl with hematocolpometra

Background. Imperforate hymen is usually treated with hymenotomy, and the management after its spontaneous rupture is not very well known. Case. In this paper, we present spontaneous rupture of the imperforate hymen in a 13-year-old adolescent girl with hematocolpometra just before a planned hymenotomy operation. The patient was managed conservatively with a satisfactory outcome. Conclusion. Hymenotomy may not be needed in cases with spontaneous rupture of the imperforate hymen if adequate opening for menstrual discharge is warranted.

Hematocolpos causing severe urinary retention in an adolescent girl with imperforate hymen: an uncommon presentation

INTRODUCTION

Hematocolpos is rarely presented as a pelvic mass which mechanically compresses the bladder and the urethra thereby causing urinary retention.

CASE REPORT

A 12-year-old girl referred with the history of lower abdominal pain and retention of urine for 24 h. The patient had not started her menses yet. Three weeks before she also complained of discomfort on passing urine, frequency and urgency and was taken to a local outpatient clinic where she was given antibiotics with the diagnosis of urinary tract infection, she had also the history of intermittent urinary catheterization (three times before) in an emergency department because of acute severe urinary retention. Transabdominal ultrasonography revealed a pelvic semi-solid mass suggestive of hematocolpos. Pelvic examination revealed a pale blue imperforate hymen bulging from the vaginal introitus outwards. A cruciate incision was made over the hymen. Postoperative period was uneventful.

CONCLUSION

In case of acute severe urinary retention in an adolescent girl, the clinicians should keep in mind that imperforate hymen may be a causative factor and this condition may easily be treated surgically.