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Aljahdali EA, Kurdi MO. Hymen-saving hymenotomy of imperforate hymen in neonates and adolescents: tertiary medical center experience. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
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.
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Mallmann MR, Reutter H, Mack-Detlefsen B, Gottschalk I, Geipel A, Berg C, Boemers TM, Gembruch U. Prenatal Diagnosis of Hydro(metro)colpos: A Series of 20 Cases. Fetal Diagn Ther 2018; 45:62-68. [PMID: 29478043 DOI: 10.1159/000486781] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/29/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hydrocolpos and hydrometrocolpos are rare malformations caused by accumulation of secretion due to congenital obstruction of the vagina. Hydro(metro)colpos may be isolated or can be combined with other malformations as part of a syndromic disorder. We report on a series of 20 cases with hydro(metro)colpos diagnosed prenatally, delineate the differential diagnoses, and illustrate the spectrum of associated malformations. SUBJECTS AND METHODS This was a retrospective study involving 20 fetuses with hydro(metro)colpos at two large tertiary referral centers in Germany over an 18-year period (2000-2017). RESULTS The median diagnosis was made at 30+4 weeks of gestation, the earliest at 20+6 weeks, the latest at 37+2 weeks. All 20 fetuses presented with the typical cystic structure behind the fetal bladder. Additional malformations included urogenital malformations, hexadactyly, and heart defects. Postnatal follow-up revealed that hydro(metro)colpos was associated with anorectal malformation in 11/20 fetuses, McKusick-Kaufman syndrome or Bardet-Biedl syndrome in 4/20 fe tuses, Mayer-Rokitansky-Küster-Hauser syndrome in 3/20 fetuses, and Herlyn-Werner-Wunderlich syndrome in 1/20. In 1 fetus pressure from an intraabdominal teratoma resulted in prenatal hydro(metro)colpos. CONCLUSION Hydro(me tro)colpos is a rare prenatal sonographic feature. Multidisciplinary prenatal counseling should include all potential syndromes that can present with hydro(metro)colpos in the prenatal setting.
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Affiliation(s)
- Michael R Mallmann
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, .,Department of Obstetrics and Gynecology, University of Cologne, Cologne,
| | - Heiko Reutter
- Department of Neonatology and Pediatric Intensive Care, University of Bonn, Bonn, Germany.,Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Birte Mack-Detlefsen
- Department of Pediatric Surgery and Pediatric Urology, Children's Hospital of Cologne, Cologne, Germany
| | - Ingo Gottschalk
- Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.,Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Thomas M Boemers
- Department of Pediatric Surgery and Pediatric Urology, Children's Hospital of Cologne, Cologne, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
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Tilahun B, Woldegebriel F, Wolde Z, Tadele H. Hydrometrocolpos Presenting as a Huge Abdominal Swelling and Obstructive Uropathy in a 4 Day Old Newborn: A Diagnostic Challenge. Ethiop J Health Sci 2016; 26:89-91. [PMID: 26949322 PMCID: PMC4762965 DOI: 10.4314/ejhs.v26i1.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Abdominal swelling is an uncommon presentation in newborn babies. A combination of huge abdominal swelling, obstructive uropathy and imperforate hymen in newborns has not been reported in the medical literature. Case Details We report a 4 days old newborn with a rare presentation of hydrometrocolpos which posed a diagnostic challenge and consequently resulted in delays in diagnosis and treatment. Conclusion Hydrometrocolpos should be considered as a differential diagnosis in neonates who present with huge abdominal swelling.
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Ben Hamouda H, Ghanmi S, Soua H, Sfar MT. [Spontaneous rupture of the imperforate hymen in two newborns]. Arch Pediatr 2016; 23:275-8. [PMID: 26857644 DOI: 10.1016/j.arcped.2015.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/04/2015] [Accepted: 11/21/2015] [Indexed: 12/26/2022]
Abstract
Imperforate hymen is the most frequent congenital malformation of the female genital tract and usually remains asymptomatic until puberty. The diagnosis of this malformation is rarely made at birth and surgical treatment is often by hymenotomy. However, spontaneous rupture of the imperforate hymen is possible but is very rare. We report two cases of imperforate hymen revealed by mucocolpos at birth. Ultrasound examination does not objectify hydrocolpos or hydrometrocolpos. Spontaneous rupture of the imperforate hymen was observed respectively in the 4th and 7th day of life with a satisfactory result at 1 month of age. Screening for the imperforate hymen must be systematic at birth to offer early hymenotomy if the spontaneous rupture is not adequate and prevent serious complications of the disease at puberty.
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Affiliation(s)
- H Ben Hamouda
- Service de pédiatrie et de néonatologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie.
| | - S Ghanmi
- Service de pédiatrie et de néonatologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - H Soua
- Service de pédiatrie et de néonatologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - M T Sfar
- Service de pédiatrie et de néonatologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
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Abdominal tumor in a 14-year-old adolescent: imperforate hymen, resulting in hematocolpos-a case report and review of the literature. Case Rep Obstet Gynecol 2015; 2015:429740. [PMID: 25737786 PMCID: PMC4337051 DOI: 10.1155/2015/429740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/17/2015] [Accepted: 01/19/2015] [Indexed: 11/17/2022] Open
Abstract
Background. Abdominal masses in female adolescents are uncommon. A rare cause of this condition is hematocolpos due to imperforate hymen. Case. We present a case of an unusually massive asymptomatic abdominal bulk in a 14-year-old female patient, who sought for medical advice after unusual abdominal pain lasting for few weeks. The patient was otherwise asymptomatic, apart from an unusual dramatic expansion of her abdominal wall during the last month. We describe the surgical management and the follow-up of the patient. Summary and Conclusion. Clinicians should keep in mind that an imperforate hymen can cause abdominal growth due to hematocolpos and include it in the differential diagnosis of such a clinical entity in female adolescents. 2D ultrasound is usually efficient for the confirmation of the diagnosis of hematocolpos, but 3D ultrasound is more accurate. Wide excision should be undertaken, as an initial approach, to avoid recurrence.
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Vitale V, Cigliano B, Vallone G. Imperforate hymen causing congenital hydrometrocolpos. J Ultrasound 2013; 16:37-9. [PMID: 24046799 DOI: 10.1007/s40477-013-0009-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 12/08/2012] [Indexed: 11/29/2022] Open
Abstract
A 3-day-old girl in good health was referred to our department for the evaluation of an abdominal mass detected at birth. Prenatal ultrasound (US) examinations had shown no anomaly. US examination revealed the presence of a hypoechoic and corpusculated cystic formation of about 8 × 5 × 4 cm located in the mid region of the abdomen. The uterus was not visible and the kidneys were normal with no sign of hydronephrosis. The ovaries were normal. Physical examination confirmed US findings revealing the presence of a curved membrane which covered the vaginal opening. Based on these findings, the patient was diagnosed to have hydrometrocolpos. Hymenectomy was performed and about 100 ml of milky fluid was subsequently removed by aspiration. The patient presented no other congenital anomalies and US follow-up showed a normal structure of the uterus.
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Affiliation(s)
- V Vitale
- Divisione di Diagnostica Pediatrica, Dipartimento di Scienze Biomorfologiche e Funzionali, Università Federico II di Napoli, Naples, Italy
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Nagai K, Murakami Y, Nagatani K, Nakahashi N, Hayashi M, Higaki T, Ishii E. Life-threatening acute renal failure due to imperforate hymen in an infant. Pediatr Int 2012; 54:280-2. [PMID: 22507153 DOI: 10.1111/j.1442-200x.2011.03422.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kozo Nagai
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan
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Abu-Ghanem S, Novoa R, Kaneti J, Rosenberg E. Recurrent Urinary Retention Due to Imperforate Hymen After Hymenotomy Failure: A Rare Case Report and Review of the Literature. Urology 2011; 78:180-2. [DOI: 10.1016/j.urology.2010.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 09/28/2010] [Accepted: 10/14/2010] [Indexed: 10/18/2022]
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Nohuz E, Moreno W, Varga J, Tamburro S, Yanez M, Loriette Y, Leonenko M, Bayeh S, Mage G. Imperforation hyménéale : un diagnostic peut en cacher un autre. Arch Pediatr 2010; 17:394-7. [PMID: 20207524 DOI: 10.1016/j.arcped.2010.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 09/08/2009] [Accepted: 01/31/2010] [Indexed: 11/16/2022]
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Algin O, Erdogan C, Kilic N. Ultrasound-guided percutaneous drainage of neonatal pyometrocolpos under local anesthesia. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S271-6. [PMID: 20130873 DOI: 10.1007/s00270-010-9814-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 01/08/2010] [Indexed: 11/28/2022]
Abstract
Hydrometrocolpos is an uncommon congenital disorder with cystic dilatation of the vagina and uterus that occurs as a result of accumulated secretions from the reproductive tract due to distal genital tract obstruction. Secondary infection may also occur, resulting in pyometrocolpos, a potentially lethal disease. Immediate drainage of the cystic mass in patients determined to have pyometrocolpos is required to prevent or treat uropathy and septicemia until definitive corrective surgery can be performed. We report an unusual cause of obstructive uropathy in three infants: pyometrocolpos due to lower genital tract atresia. Ultrasound-guided percutaneous drainage of the pyometrocolpos resulted in dramatically improved clinical and laboratory findings in these patients. Ultrasound-guided percutaneous drainage under local anesthesia is a simple, minimally invasive, safe, and effective procedure that facilitates later successful corrective surgery and avoids the need for more complex drainage procedures.
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Affiliation(s)
- Oktay Algin
- Department of Radiology, Atatürk Training and Research Hospital, Bilkent, Ankara, Turkey.
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11
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Ozturk H, Yazici B, Kucuk A, Senses DA. Congenital imperforate hymen with bilateral hydronephrosis, polydactyly and laryngocele: A rare neonatal presentation. Fetal Pediatr Pathol 2010; 29:89-94. [PMID: 20334483 DOI: 10.3109/15513811003620609] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Imperforate hymen is a rare congenital malformation to present with symptoms in the neonatal period. We present a case of a 5-day-old neonate with a marked interlabial swelling causing urinary retention. Imaging revealed hydrometrocolpos, hydrosalpinx, and bilateral hydronephrosis. Additionally, our patient had polydactyly of both feet and hands, and laryngocele that have not been previously described in literature. Hymenectomy is the mainstay of management to prevent the development of hematocolpos, pain, and possible retrograde menstruation.
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Affiliation(s)
- Hulya Ozturk
- Department of Pediatric Surgery, Duzce University, Turkey.
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12
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Hymen sparing surgery for imperforate hymen: case reports and review of literature. J Pediatr Adolesc Gynecol 2009; 22:e61-4. [PMID: 19646660 DOI: 10.1016/j.jpag.2008.03.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 03/21/2008] [Accepted: 03/25/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND Imperforate hymen, with an incidence between 0.1% and 0.05%, is the most common obstructive congenital abnormality of the female genital tract. 'Standard' surgical treatment of imperforate hymen involves hymenectomy after a cruciate, plus, or X-shaped hymenotomy incision. CASES Two cases with imperforate hymen treated with a simple vertical incision are presented. A few oblique sutures were used to prevent refusion. Postoperative follow up was uneventful. SUMMARY AND CONCLUSION The importance of the integrity of hymen changes in different cultures and religious groups. Option of a hymen sparing procedure is readily preferred by most of these patients and families. Also preservation of hymenal tissue, hence the perception of 'integrity' of female genitalia, might be an alternative treatment option.
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Johal NS, Bogris S, Mushtaq I. Neonatal imperforate hymen causing obstruction of the urinary tract. Urology 2009; 73:750-1. [PMID: 19118883 DOI: 10.1016/j.urology.2008.10.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2008] [Revised: 10/05/2008] [Accepted: 10/07/2008] [Indexed: 11/19/2022]
Abstract
An imperforate hymen associated with urinary retention, bilateral hydronephrosis, and bilateral hydrosalpinx is extremely rare in the neonatal period. We present a case of a 2-day-old neonate with a marked interlabial swelling causing urinary retention. Imaging revealed hydrometrocolpos, hydrosalpinx, and bilateral hydronephrosis. Her symptoms resolved after hymenectomy.
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Affiliation(s)
- Navroop S Johal
- Department of Paediatric Urology, Great Ormond Street Hospital for Children, National Health Service Trust, London, United Kingdom.
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14
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Cherian MP, Al-Sanna'a NA, Ayyat FM. Hydrometrocolpos and acute renal failure: a rare neonatal presentation of Bardet-Biedl syndrome. J Pediatr Urol 2008; 4:313-6. [PMID: 18644538 DOI: 10.1016/j.jpurol.2007.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2007] [Accepted: 10/19/2007] [Indexed: 11/28/2022]
Abstract
The presence of hydrometrocolpos and postaxial polydactyly in a neonate can be caused by two genetic conditions; namely, McKusick-Kaufman syndrome and Bardet-Biedl syndrome. There are no distinct clinical features that allow discrimination between the two syndromes, as the cardinal features of rod-cone dystrophy, obesity, learning disability and renal dysfunction in Bardet-Biedl syndrome are age dependent. McKusick-Kaufman syndrome is characterized by vaginal atresia with hydrometrocolpos, postaxial polydactyly and congenital heart defect. Here we report an unusual presentation of Bardet-Biedl syndrome: a neonate born in a consanguineous family having an older sibling diagnosed with Bardet-Biedl syndrome presenting with postaxial polydactyly and vaginal atresia; the latter causing hydrometrocolpos, hydronephrosis and renal failure. Relief of urinary obstruction by exploratory laparotomy and aspiration of fluid, and vaginal reconstruction gradually reversed the hydronephrosis and renal failure. The patient developed end-stage renal failure towards the end of her first decade, possibly due to underlying renal pathology associated with Bardet-Biedl syndrome.
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Vila Cots J, Camacho Díaz J, Giménez Llort A, Vila Santandreu A, Blanch J. Ureterohidronefrosis bilateral secundaria a hidromucocolpos de diagnóstico prenatal. An Pediatr (Barc) 2008; 69:95-6. [DOI: 10.1157/13124229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Chang JW, Yang LY, Wang HH, Wang JK, Tiu CM. Acute urinary retention as the presentation of imperforate hymen. J Chin Med Assoc 2007; 70:559-61. [PMID: 18194899 DOI: 10.1016/s1726-4901(08)70061-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Acute urinary retention is unusual in children and is usually a candidate for visiting the emergency department upon initial discovery. We report a 12-year-old girl who complained of acute urinary retention. Ultrasonography demonstrated a large echogenic mass over the vagina and mild dilation of the uterus. Imperforate hymen associated with hematocolpos and hematometrium was diagnosed. Cruciate hymenotomy was performed. The symptoms resolved after treatment. Adolescent girls who complain of urinary symptoms with no previous menstruation should have their external genitalia examined in order to rule out the possibility of imperforate hymen as the cause of acute urinary retention.
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Affiliation(s)
- Jei-Wen Chang
- Department of Pediatrics, Taipei Veterans General Hospital, and Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan, R O C
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Dursun I, Gunduz Z, Kucukaydın M, Yıldırım A, Yılmaz A, Poyrazoglu HM. Distal vaginal atresia resulting in obstructive uropathy accompanied by acute renal failure. Clin Exp Nephrol 2007; 11:244-246. [PMID: 17891355 DOI: 10.1007/s10157-007-0488-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 06/28/2007] [Indexed: 12/01/2022]
Abstract
Children with hydrometrocolpos due to distal vaginal atresia may present with severe obstructive uropathy. Here we report a 27-day-old infant with a hydrometrocolpos causing life-threatening renal failure. Percutaneous drainage of the hydrometrocolpos resulted in dramatically improved clinical and laboratory findings in the patient.
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Affiliation(s)
- Ismail Dursun
- Department of Pediatric Nephrology, Erciyes University Faculty of Medicine, Bahçelievler Mah, Mevlana Cad, Nihavend Sok, No. 10/10 38039, Talas/Kayseri, Turkey.
| | - Zubeyde Gunduz
- Department of Pediatric Nephrology, Erciyes University Faculty of Medicine, Bahçelievler Mah, Mevlana Cad, Nihavend Sok, No. 10/10 38039, Talas/Kayseri, Turkey
| | - Mustafa Kucukaydın
- Department of Pediatric Surgery, Erciyes University Faculty of Medicine, Talas/Kayseri, Turkey
| | - Afra Yıldırım
- Department of Pediatric Radiology, Erciyes University Faculty of Medicine, Talas/Kayseri, Turkey
| | - Aysegul Yılmaz
- Department of Pediatrics, Erciyes University Faculty of Medicine, Talas/Kayseri, Turkey
| | - Hakan M Poyrazoglu
- Department of Pediatric Nephrology, Erciyes University Faculty of Medicine, Bahçelievler Mah, Mevlana Cad, Nihavend Sok, No. 10/10 38039, Talas/Kayseri, Turkey
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