Imperforation hyménéale : un diagnostic peut en cacher un autre

Imperforate hymen causing hematocolpos, hematometra and acute urinary retention in an adolescent girl

Abdominal pain is a common occurrence in the adolescent demographic, encompassing a wide range of differential diagnoses. The etiology of abdominal pain can be categorized into gastrointestinal, urologic, and gynecologic causes. In the female pediatric population, acute urinary retention is an uncommon but noteworthy source of abdominal pain, typically resulting from an obstructive process. Hence, it is imperative to perform a comprehensive physical examination prior to deciding on the management approach. We present the case of a 11-year-old girl who visited the emergency department due to suprapubic discomfort and acute urinary retention. The patient had no significant medical or surgical history, and her neurological examinations were normal. Urinary catheterization drained 500 mL of urine. Abdominal ultrasonography revealed a hematocolpos compressing the urinary bladder. Further gynecologic history indicated that the patient had not yet experienced menarche. Consequently, a cruciate incision was performed, which resolved her urinary retention. This article aims to emphasize that although rare, imperforate hymen should be considered as a potential cause of acute urinary retention during adolescence. If an adolescent presents with abdominal pain and voiding difficulties, it is crucial to obtain a detailed gynecological history and conduct a thorough physical examination of the genital introitus.

Imperforate hymen mimicking acute appendicitis in an adolescent woman: a rare presentation

Imperforate hymen is a rare congenital malformation of the female genital tract. The condition poses several diagnostic challenges owing to its low incidence and often atypical presentation. Classical symptoms include amenorrhoea and cyclical abdominal pain. Delayed diagnosis leads to potentially irreversible and lifechanging sequelae including infertility, endometriosis and renal failure. A premenarchal 13-year-old girl with a background of chronic constipation presented with symptoms mimicking acute appendicitis. The underlying cause was imperforate hymen and retrograde menstruation. The diagnosis was made during diagnostic laparoscopy. As with this patient, pre-existing symptoms are often troublesome long before the true diagnosis is made. This case report highlights the importance of recognising imperforate hymen as a potential cause of acute abdominal pain in premenarchal adolescent girls. The clinical picture may present as right or left iliac fossa pain. Early identification reduces the risk of adverse complications and avoids unnecessary and potentially harmful interventions.

[Spontaneous rupture of the imperforate hymen in two newborns]

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.

[Pelvic mass in a young girl: think of hematocolpos]

L'hématocolpos est l'accumulation progressive du sang menstruel dans la cavité vaginale à la puberté. Il est souvent la conséquence d'une imperforation de l'hymen. Il se traduit sur le plan clinique par des douleurs pelviennes cycliques et une aménorrhée primaire. Plus rarement, il peut se révéler par une masse pelvienne. L’échographie est l'examen de choix pour le diagnostic de l'hématocolpos sur imperforation de l'hymen. L'imagerie par résonance magnétique (IRM) est l'examen d'imagerie de référence pour confirmer l'hématolcolpos et exclure d'autres malformations du canal de Muller ou des malformations urologiques associées. Nous rapportons un cas d'hématocolpos secondaire à une imperforation hyménéale diagnostiqué chez une jeune fille présentant une aménorrhée primaire et une masse pelvienne. Le diagnostic était posé par l’échographie et l'IRM et confirmé par l'intervention chirurgicale.

[Hydrocolpos and hydrometrocolpos in newborns]

Hydrocolpos and the hydrometrocolpos are anomalies resulting from vaginal and uterine retention and accumulation of cervicovaginal secretions caused by congenital malformation. It is a rare pathology affecting the female newborn and infant and much less often young girls. It appears clinically as an abdominal mass associated with absence or abnormality of the vaginal opening. The diagnosis is confirmed by abdominal echography and CT scan. Treatment varies from the simple X-shaped hymenotomy for the isolated imperforate hymen to major surgery for substantial retentions and complex urogenital abnormalities. The authors report two cases of hydrocolpos and hydrometrocolpos discovered in the neonatal period. These were two newborn babies resulting from poorly followed pregnancies at which the clinical examination noted in both cases a large abdominal mass. The physical examination, imagery and surgical exploration demonstrated the existence of enormous hydrocolpos with imperforate hymen in 1 case and hydrometrocolpos with distal vaginal atresia in the second case. The treatment consisted of draining the secretions for both patients, after an X-shaped hymenotomy for the first and after section anastomosis of the vaginal atresia for the second. Both cases progressed favorably.