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Jouza M, Rejdova I, Cintula L, Jouzova A, Jabandziev P. Hydrocolpos causing bowel obstruction in a preterm newborn: a case report. Matern Health Neonatol Perinatol 2024; 10:10. [PMID: 38693566 PMCID: PMC11064300 DOI: 10.1186/s40748-024-00179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/21/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Imperforate hymen is the most common congenital defect of the female urogenital tract. The spectrum of clinical manifestations is broad, ranging from mild cases undiagnosed until adolescence to severe cases of giant intraabdominal masses. The most common complication of hydrocolpos is bladder compression, resulting in obstructive uropathy and hydronephrosis. CASE PRESENTATION We present here the case of a preterm neonate who was admitted to the surgical neonatal intensive care unit for bowel obstruction. The baby did not appear septic or unwell, a small amount of meconium passed frequently, and no bilious gastric residuals occurred. Based on these findings, acute abdominal obstruction was doubtful, and the surgeon chose a conservative (watch and wait) approach. Subsequently, we performed abdominal ultrasound and magnetic resonance imaging based on unclear information about a suspicious abdominal mass raised by the gynecologist shortly before the emergency C-section. The final diagnosis was congenital hydrocolpos due to imperforate hymen. The pediatric gynecologist indicated an incision of the imperforate hymen under general anesthesia. The incision resolved abdominal distention as well as the bowel obstruction. CONCLUSION The presentation of hydrocolpos was not typical (no bulging in the vaginal introitus) in our case, and clinical symptoms implied acute bowel obstruction shortly after birth. The surgeon chose a conservative (watch and wait) approach as the baby did not appear unwell on the second day of life. Fortunately, diagnostic laparotomy was not required as the next step in bowel obstruction management. All clinical symptoms resolved after a minor surgical procedure.
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Affiliation(s)
- Martin Jouza
- Department of Pediatrics, University Hospital Brno, Cernopolni 9, 613 00, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ingrid Rejdova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic
| | - Lukas Cintula
- Department of Pediatrics, University Hospital Brno, Cernopolni 9, 613 00, Brno, Czech Republic
| | - Anna Jouzova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic
| | - Petr Jabandziev
- Department of Pediatrics, University Hospital Brno, Cernopolni 9, 613 00, Brno, Czech Republic.
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Ibishi VA, Latifi H, Ibishi L. Ultrasonographic examination and resolution of a pronounced hematocolpometra linked to an imperforate hymen: A detailed case study. Radiol Case Rep 2023; 18:4119-4122. [PMID: 37732002 PMCID: PMC10507056 DOI: 10.1016/j.radcr.2023.08.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/12/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
An imperforate hymen is a rare malformation present at birth; however, in most cases, diagnosis is missed until adolescence, when hematocolpometra and its symptoms develop. At this stage, every further delay in diagnosis and treatment will negatively affect the quality of life of young females. It may also be one of the causes of endometriosis and its consequences, such as subfertility. Sonography of the pelvis and physical examination are the diagnostic modalities of choice for diagnosing hematocolpometra and imperforate hymen. We present a case of a 14-year-old patient admitted to the obstetrics and gynecology clinic with complaints of lower abdominal pain and urinary retention following dysuria. The patient was previously examined by a family doctor who misidentified the issue and treated it as a urinary infection. After the symptoms worsened, the patient was referred to a gynecologist. An ultrasound examination showed a distended vagina and uterus, suggesting hematocolpometra, and after further inspection, it was revealed to be caused by an imperforate hymen. A hymenectomy was performed, and about 900 mL of blood was drained. Symptoms and complaints ceased, and the patient was discharged the next day.
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Affiliation(s)
- Vlora Ademi Ibishi
- Medical Faculty, University of Prishtina” Hasan Prishtina”, Prishtina, Kosovo
- Obstetrics and Gynecology Clinic, University Clinical Center of Kosova, Prishtina, Kosovo
| | - Hajrullah Latifi
- Obstetrics and Gynecology Clinic, University Clinical Center of Kosova, Prishtina, Kosovo
- University” Fehmi Agani” Gjakova, Kosovo
| | - Lena Ibishi
- Central European University, Vienna, Austria
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Uygur L, Demirci O, Celayir A. Fetal hydrometrocolpos: Challenges of prenatal differential diagnosis on ultrasound. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:426-431. [PMID: 36152021 DOI: 10.1002/jcu.23345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/03/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Hydrometrocolpos is a pelvic cystic mass representing the distension of the vagina and uterus due to a lower genital tract obstruction causing accumulation of utero-cervical-vaginal secretions or urine in the vagina and endometrial cavity. Prenatal diagnosis is uncommon and differential diagnosis of the underlying etiologies is quite challenging in the prenatal period. We present three cases of female fetuses with hydrometrocolpos and discuss the prenatal differential diagnoses in the light of ultrasound findings along with postnatal diagnoses and outcomes.
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Affiliation(s)
- Lütfiye Uygur
- Department of Obstetrics and Gynecology, Division of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Department of Obstetrics and Gynecology, Division of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ayşenur Celayir
- Department of Pediatric Surgery, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
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Wang Y, Wang X, Zeng K, Wang B, Zhao D, Yang Z, Chen L. Fetal Abdominal Cystic Masses: Clinical Spectrum and Prenatal Ultrasound Diagnosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2775-2787. [PMID: 35170798 DOI: 10.1002/jum.15963] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/20/2022] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To assess the diagnostic accuracy of prenatal ultrasound in detecting intra-abdominal masses derived from different systems. METHODS Fetuses diagnosed with abdominal cystic masses during prenatal ultrasound were included in this study. The basic biological parameters of the fetus were measured in addition to the location of the cystic mass, the shape and size of the mass, the thickness of the cystic wall, dynamic changes, blood supply of the mass, and relationship with the surrounding organs. Whether the fetus also had other malformations was also recorded. Clinical data were followed up to 6 months after birth. RESULTS Between January 1, 2019 and January 1, 2021, 247 fetuses were included, most of which contained renal/adrenal cystic masses (n = 93, 37.7%), followed by hepatobiliary system (n = 48, 19.4%), gastrointestinal tract (n = 45, 18.2%), reproductive system (n = 29, 11.7%), and ureter and bladder (n = 27, 10.9%) masses, respectively. The minority were masses in other systems (n = 5, 2.0%). The overall prenatal diagnostic accuracy was 90.7%. There were significant differences in each system (χ2 = 13.0, P < .05). The most accurate type of cyst was diagnosed from renal and adrenal (96.8%) cases, followed by ureter and bladder (92.6%) cases, gastrointestinal tract (91.1%), hepatobiliary system (85.4%), and reproductive system (82.8%). Other systems (60.0%) were the least accurate type. CONCLUSIONS A wide variety of cystic masses can be accurately detected in the fetal abdomen, and most of these lesions can be accurately diagnosed during pregnancy.
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Affiliation(s)
- Yaqin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoguang Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Kaihui Zeng
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bing Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dan Zhao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zeyu Yang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lizhu Chen
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Supangat, Tohari AI, Nugraha MY, Sakinah EN, Imtiyazfauz S, Athoillah N, Fahrudin Hidayat MR. Unusual symptom of abdominal pain in imperforate hymen mimicking acute appendicitis: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Hydro-metro-colpos diagnosed in utero. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
RATIONALE Hydronephrosis, mostly caused by ureteropelvic junction obstruction, rarely occurs in infants. However, imperforate hymen atresia in female infants may cause hydronephrosis, even though it is rare. PATIENT CONCERNS A 3-month-old female infant was admitted to our hospital for frequent crying. There was no significant past medical history. DIAGNOSES Following ultrasound imaging, the patient was diagnosed with hydronephrosis possibly caused by imperforate hymen. INTERVENTIONS The infant underwent hymenotomy with a cruciate incision to prevent future complications such as acute renal injury. OUTCOMES Hydronephrosis resolved after the operation. The outcome was very good, with no complications in the postoperative period. CONCLUSIONS Early ultrasound diagnosis plays a significant role in the management and treatment of infant patients. Ultrasound is the mandatory imaging technology for determining the cause of hydronephrosis.
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Affiliation(s)
- Meixiang Zhang
- Department of Ultrasound, The Maternal and Child Health Care Hospital of Hunan Province
| | - Yingchun Luo
- Department of Ultrasound, The Maternal and Child Health Care Hospital of Hunan Province
| | - Sheng Wang
- Department of Ultrasound, The Children Hospital of Hunan Province, Changsha, China
| | - Siyao Wang
- Department of Ultrasound, The Maternal and Child Health Care Hospital of Hunan Province
| | - Haiyan Kuang
- Department of Ultrasound, The Maternal and Child Health Care Hospital of Hunan Province
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Amitai E, Lior Y, Sheiner E, Saphier O, Leron E, Silberstein T. The impact of hymenectomy on future gynecological and obstetrical outcomes. J Matern Fetal Neonatal Med 2020; 33:1400-1404. [PMID: 30173591 DOI: 10.1080/14767058.2018.1519539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Imperforated hymen is a rare condition usually diagnosed at puberty due to amenorrhea accompanied by cyclic pelvic pain and sometimes other significant complications such as hematometra, endometriosis, and infertility. The accepted surgical treatment for imperforate hymen and some other hymenal malformation is hymenectomy. However, given low incidence rates, long-term obstetrical and gynecological outcomes in post-hymenectomy women remain poorly understood.Objective: To investigate long-term obstetrical and gynecological outcomes in nulliparous women who underwent a hymenectomy.Study design: Retrospective study comparing gynecological and perinatal outcomes of nulliparous women with and without hymenectomy, who delivered between the years 1988 and 2015 at the Soroka University Medical Center. Univariate analysis was performed as accepted with multivariate logistic regression model used to assess long-term effects of hymenectomy.Results: During the study period, 56 of 74,598 nulliparous women who delivered at the Soroka University Medical Center had previously undergone a hymenectomy. In a univariate analysis, cesarean deliveries were significantly more prevalent among women who had undergone a hymenectomy (30.4 versus 17.6% p = .01) as were infertility treatments (10.7 versus 4.4% p = .04) and dyspareunia (42.9 versus 0.2% p <.001). In a multivariate logistic regression model hymenectomy was found to be an independent risk factor for significant obstetrical and gynecological outcomes defined as one or more of the following: caesarean deliveries, cervical laceration, vaginal laceration, perineal laceration, preterm delivery, cervical incompetence, endometriosis, infertility, and dyspareunia (OR 2.5, 95% CI 1.26-4.93; p = .001).Conclusions: Hymenectomy is associated with significant long-term obstetrical and gynecological complications. Informing medical teams of these risks might promote early detection and minimize associated complications such as laceration-associated blood loss and preterm delivery.
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Affiliation(s)
- Eitan Amitai
- Faculty for Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Yotam Lior
- Faculty for Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Soroka Clinical Research Center, Soroka University Medical Center, Be'er-Sheva, Israel
| | - Eyal Sheiner
- Faculty for Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Be'er-Sheva, Israel
| | - Oshra Saphier
- Department of Chemical Engineering, Sami Shamoon College of Engineering, Be'er-Sheva, Israel
| | - Elad Leron
- Faculty for Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Be'er-Sheva, Israel
| | - Tali Silberstein
- Faculty for Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Be'er-Sheva, Israel
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Lee KH, Hong JS, Jung HJ, Jeong HK, Moon SJ, Park WH, Jeong YM, Song SW, Suk Y, Son MJ, Lim JJ, Shin JI. Imperforate Hymen: A Comprehensive Systematic Review. J Clin Med 2019; 8:jcm8010056. [PMID: 30621064 PMCID: PMC6352236 DOI: 10.3390/jcm8010056] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/29/2018] [Accepted: 01/03/2019] [Indexed: 12/28/2022] Open
Abstract
Imperforate hymen (IH) is an uncommon congenital anomaly of the female genital tract, with the hymen completely obstructing the vaginal opening. Despite the simple diagnosis and treatment of IH, missed or delayed diagnosis is often a clinical problem owing to its low incidence, nonspecific symptoms, or insufficient physical examination. The aim of this study is to identify the characteristics, clinical presentations, treatment modalities, and outcomes of imperforate hymen patients. In this study, a literature search of PubMed databases was performed for sources published up to 3 July 2018 for English-language studies with the term “imperforate hymen”. The literature review identified 251 citations and 155 articles (143 case reports, 12 case series) containing 253 patients who were finally included (two papers were not written in English). Among 236 postnatal patients, the mean age of the patients was 10.7 ± 4.7 years. Abdominal pain (54.2%), urinary retention (20.3%), abnormal menstruation (14.0%), dysuria (9.7%), increased urinary frequency (5.1%), severe presentation of renal failure (n = 5, 2.1%), and urinary tract infection (n = 1, 0.4%) were presented. Most patients diagnosed with the condition underwent surgical treatment (83.5%), most of whom were treated via a hymenotomy (35.2%) and hymenectomy (36.4%), and the use of prophylactic antibiotics were only used in 7 patients. There were no differences in outcomes between two surgical methods. In addition, 141 (59.7%) patients showed improvement and 5 deceased patients were not related to IH or the operation itself; Complications, such as vaginal adhesion, were only noted in 6.6% of patients. In addition, among 17 cases of newborns with a diagnosis of IH before birth, hymenectomy (n = 5, 29.4%) and hymenotomy (n = 9, 52.9%) were the main treatment modalities and showed improved prognosis in 52.9% of newborns. Because IH diagnosis is easy and postsurgical prognosis is good, clinicians should carefully examine every female patient at birth. IH should be considered regarding adolescent girls with abdominal pain, lower back pain, or urinary retention, and perform appropriate physical examinations of the genital introitus. In addition, accurate diagnosis as IH, not misdiagnosing as vaginal septum or agenesis, is important to prevent severe complications such as stricture and ascending infection.
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Affiliation(s)
- Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 120-752, Korea.
- Division of Pediatric Nephrology, Severance Children's Hospital, Seoul 03722, Korea.
| | - Ji Sun Hong
- Yonsei University Wonju College of Medicine, Wonju 26426, Korea.
| | - Hyuk Jun Jung
- Yonsei University College of Medicine, Seoul 120-752, Korea.
| | - Hyun Ki Jeong
- Yonsei University College of Medicine, Seoul 120-752, Korea.
| | - Seo Jin Moon
- Yonsei University College of Medicine, Seoul 120-752, Korea.
| | - Woo Hyun Park
- Yonsei University College of Medicine, Seoul 120-752, Korea.
| | - Yoon Mi Jeong
- Yonsei University College of Medicine, Seoul 120-752, Korea.
| | - Seung Won Song
- Yonsei University College of Medicine, Seoul 120-752, Korea.
| | - Yongjune Suk
- Yonsei University College of Medicine, Seoul 120-752, Korea.
| | - Min Ji Son
- Yonsei University College of Medicine, Seoul 120-752, Korea.
| | - Jae Jung Lim
- Yonsei University College of Medicine, Seoul 120-752, Korea.
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul 120-752, Korea.
- Division of Pediatric Nephrology, Severance Children's Hospital, Seoul 03722, Korea.
- Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul 03722, Korea.
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Garcia Rodriguez R, Pérez González J, Garcia Delgado R, Rodriguez Guedes A, de Luis Alvarado M, Medina Castellano M, Garcia Hernandez JA. Fetal hydrometrocolpos and congenital imperforate hymen: Prenatal and postnatal imaging features. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:549-552. [PMID: 29570797 DOI: 10.1002/jcu.22588] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/21/2018] [Accepted: 02/23/2018] [Indexed: 06/08/2023]
Abstract
Congenital imperforate hymen is probably the most common obstructive anomaly of the female reproductive tract. The accumulation of fluid in the genital tract leads to a distended uterus and vagina, causing hydrometrocolpos. Prenatal diagnosis of fetal hydrometrocolpos is uncommon, with only 22 cases reported in the literature and only a few cases of prenatal imaging of this condition available to date. The main ultrasound finding is a fetal pelvic mass posterior to the bladder and anterior to the rectum. We present the case of a 37-week female fetus with a fetal pelvic mass detected in a routine obstetric ultrasound examination, and the correlation between the prenatal and postnatal findings.
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Affiliation(s)
- Raquel Garcia Rodriguez
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Julio Pérez González
- Radiodiagnosis Department, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Raquel Garcia Delgado
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Azahara Rodriguez Guedes
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - María de Luis Alvarado
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Margarita Medina Castellano
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Jose Angel Garcia Hernandez
- Prenatal Diagnosis and Fetal Medicine Unit, Obstetrics and Gynecology Service, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
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Okoro PE, Obiorah C, Enyindah CE. Experience with neonatal hydrometrocolpos in the Niger Delta area of Nigeria: Upsurge or increased recognition? Afr J Paediatr Surg 2016; 13:161-165. [PMID: 28051043 PMCID: PMC5154219 DOI: 10.4103/0189-6725.194666] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hydrometrocolpos (HMC) is a clinical condition in which there is a cystic distension of the vagina (hydrocolpos), uterus and sometimes, fallopian tubes (hydrosalpinx) with fluid. This study described our experience with cases of HMC seen in our practice, and highlighted the flare in our practice. PATIENTS AND METHODS A retrospective study of cases of HMC managed at the University of Port Harcourt Teaching Hospital between September 2010 and August 2012. RESULTS There were seven cases; their ages ranged from 2 to 27 days (median 13 days). All the patients had abdominal distension but abdominal mass was obvious only in four. Other features varied depending on the presence of sepsis or other associated anomalies. The diagnosis of HMC was missed in all cases by the referring clinicians. One patient was referred with the diagnosis of tracheoesophageal fistula and esophageal atresia, 2 with bladder outlet obstruction, 1 with intestinal obstruction, 2 with anorectal malformation, and 1 with neonatal sepsis. Ultrasound identified bulky uterus in two cases and upper urinary tract dilatation in 3 patients. Six patients had laparotomy, 1 had hymenotomy only. Postoperative complications were basically wound sepsis and rectovaginal fistula resulted. CONCLUSION Diagnosis of HMC should be considered as a differential in newborn girls presenting with lower abdominal mass. Attention to clinical detail is necessary to avoid a misdiagnosis.
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Affiliation(s)
- Philemon Ekemenye Okoro
- Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - C Obiorah
- Department of Pathology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - C E Enyindah
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
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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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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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Johnson CT, Millard SE, Wang MH, Ehsanipoor RM. Prenatal diagnosis of a paraurethral cyst. J Pediatr Urol 2013; 9:e91-3. [PMID: 23146295 DOI: 10.1016/j.jpurol.2012.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/02/2012] [Indexed: 12/01/2022]
Abstract
Paraurethral cysts arising from Skene's gland are a rare cause of urogenital masses in the neonate. We report the case of a pelvic mass noted at the vaginal introitus on prenatal ultrasound that following delivery was found to be a paraurethral cyst. On prenatal ultrasound, there was no evidence of involvement of the urinary, gastrointestinal, or upper genital tract. Serial ultrasounds demonstrated slight enlargement of the cyst without other changes. The patient delivered at 33 weeks and postnatal evaluation demonstrated a paraurethral cyst. The cyst was managed expectantly and drained spontaneously on the second day of life with complete resolution.
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Affiliation(s)
- Clark T Johnson
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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15
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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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Badalyan V, Burgula S, Schwartz RH. Congenital paraurethral cysts in two newborn girls: differential diagnosis, management strategies, and spontaneous resolution. J Pediatr Adolesc Gynecol 2012; 25:e1-e4. [PMID: 22088318 DOI: 10.1016/j.jpag.2011.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 02/08/2011] [Accepted: 02/15/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND At least five types of interlabial masses of different etiologies may present in a female neonate. The more serious type of interlabial mass must be differentiated from the benign and self-resolving paraurethral or hymenal cyst. Clues include appearance and color of the mass and the location of the mass in relation to the urethral meatus and the vaginal opening. Clinicians should be able to distinguish lesions that require aggressive intervention, i.e. surgery, from those that self-resolve and merely require observation. CASE Two unrelated newborn girls each had a protruding faint-yellow-colored spherical interlabial cyst. The cyst was located anterior to the vaginal orifice and partially obscured the urethral meatus. Neither girl had any voiding problems. No other congenital anomalies were detected. Both cysts resolved rapidly and completely without surgical intervention. SUMMARY AND CONCLUSION Paraurethral cysts of the newborn and hymenal cysts rarely cause urinary obstruction or spotting, and are self-resolving. When positively identified, no evaluation of upper urinary tract is required and neither aspiration of cyst contents or marsupialization procedure is necessary.
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Affiliation(s)
- Vahe Badalyan
- Department of Pediatrics, Inova Fairfax Hospital for Children, Falls Church, Virginia, USA.
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Dosedla E, Kacerovsky M, Calda P. Prenatal diagnosis of hydrometrocolpos in a Down syndrome fetus. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:169-171. [PMID: 21387330 DOI: 10.1002/jcu.20785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 10/22/2010] [Indexed: 05/30/2023]
Abstract
We report the prenatal sonographic diagnosis of hydrometrocolpos caused by an imperforate hymen in a Down syndrome fetus, with spontaneous evacuation on the third day of life. In this case, sonographic evaluation in the 37th week revealed a large retrovesical, sharply marginated, heterogeneous, unilocular cystic structure within the fetal abdomen extending to the left side of the umbilicus.
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Affiliation(s)
- Erik Dosedla
- III. Department of Gynecology and Obstetrics, Slovak Medical University, 1st Private Hospital Košice-Šaca Inc., Košice-Šaca, Slovak Republic
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Congenital imperforate hymen with hydrocolpos and hydronephrosis associated with severe hydramnios and increase of maternal ovarian steroidogenic enzymes. J Pediatr Adolesc Gynecol 2010; 23:136-41. [PMID: 19963411 DOI: 10.1016/j.jpag.2009.10.002] [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: 08/12/2009] [Revised: 10/15/2009] [Accepted: 10/21/2009] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To study clinical features of patient presented with severe hydramnios, associated with hydronephrosis, that was antenatally diagnosed and has been successfully treated immediately after birth. At a molecular level, we investigated the gene expression of key steroidogenic enzymes from the maternal ovary. DESIGN Ultrasound scan, MRI, semi-quantitative RT-PCR SETTING: The patient was admitted to the University Hospital, University of Crete, Medical School, Greece, where all clinical data has been obtained. Gene expression studies took place at Biosciences, Brunel University, UK. RESULTS Semi-quantitative RT-PCR analyses revealed that there is upregulation of key steroidogenic genes in the maternal ovary, including steroidogenic acute regulatory protein, and the cytochrome P450 heme-containing proteins CYP11A, CYP17 and CYP19. From a clinical perspective, the prenatal ultrasound scan and MRI findings showed a multicystic pelvic mass, bilateral hydronephrosis and prior to delivery severe polyhydramnios. CONCLUSION This clinical case is the only one that we have found in the current literature where congenital imperforate hymen accompanied with hematocolpos is associated with renal obstruction in combination with polyhydramnios and increase in maternal steroidogenic enzymes.
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Abstract
Duplex/color Doppler sonography (US) is the imaging modality of choice for the evaluation of patients with primary amenorrhea. Careful correlation with clinical history, physical examination and laboratory findings significantly narrows the diagnostic possibilities thus allowing for a more precise diagnosis. This article discusses the wide gamut of etiologies of primary amenorrhea, the US appearance of pathologic processes that result in primary amenorrhea, and helps the reader understand when additional higher tech imaging is indicated.
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Sharifiaghdas F, Abdi H, Pakmanesh H, Eslami N. Imperforate hymen and urinary retention in a newborn girl. J Pediatr Adolesc Gynecol 2009; 22:49-51. [PMID: 19241622 DOI: 10.1016/j.jpag.2008.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Urinary retention is relatively rare in infants,especially in girls. Imperforate hymen is the most frequent congenital malformation of the female genital tract and is usually asymptomatic until puberty. Mucocolpos with an abdominal mass in neonatal age is extremely rare. We report a case of a 20-day-old newborn girl with acute urinary retention due to isolated imperforate hymen and mucocolpos.
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Affiliation(s)
- Farzaneh Sharifiaghdas
- Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti Medical University, Tehran, Iran.
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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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Yıldırım G, Gungorduk K, Aslan H, Sudolmus S, Ark C, Saygın S. Prenatal diagnosis of imperforate hymen with hydrometrocolpos. Arch Gynecol Obstet 2008; 278:483-5. [DOI: 10.1007/s00404-008-0603-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Accepted: 02/07/2008] [Indexed: 11/24/2022]
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Imperforate hymen: a new benign reason for highly elevated serum CA 19.9 and CA 125 levels. Arch Gynecol Obstet 2007; 277:475-7. [DOI: 10.1007/s00404-007-0493-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 10/11/2007] [Indexed: 11/26/2022]
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Picone O, Laperelle J, Sonigo P, Levaillant JM, Frydman R, Senat MV. Fetal magnetic resonance imaging in the antenatal diagnosis and management of hydrocolpos. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:105-9. [PMID: 17588226 DOI: 10.1002/uog.4062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Hydrocolpos should be considered systematically when an abdominopelvic cystic mass is diagnosed in a female fetus. Because the prognosis and neonatal management of isolated hydrocolpos with spontaneous resolution differs greatly from that of hydrocolpos associated with a cloacal malformation, it is important to ascertain prenatally whether there are associated anomalies. We report the prenatal characteristics of three fetuses with hydrocolpos; in two cases there was spontaneous resolution and one infant was born with digestive tract atresia. The principal ultrasound findings were an oblong anechoic pelvic mass with or without a sagittal septum, located behind a normal bladder. On magnetic resonance imaging (MRI), the cervical imprint on the vagina confirmed the diagnosis of hydrocolpos and helped to diagnose cloacal malformation by demonstrating the absence of meconium beside the bladder on T1 sequences. Our cases show that MRI is useful for differentiating isolated hydrocolpos from hydrocolpos associated with cloacal malformation.
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Affiliation(s)
- O Picone
- Institut national de la santé et de la recherche médicale U782, Université Paris Sud, Hôpital Antoine Béclère, Clarmart, France.
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Adaletli I, Ozer H, Kurugoglu S, Emir H, Madazli R. Congenital imperforate hymen with hydrocolpos diagnosed using prenatal MRI. AJR Am J Roentgenol 2007; 189:W23-5. [PMID: 17579130 DOI: 10.2214/ajr.05.1560] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ibrahim Adaletli
- Department of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Kocamustafapaşa, Istanbul 34300, Turkey.
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El-Messidi A, Fleming NA. Congenital imperforate hymen and its life-threatening consequences in the neonatal period. J Pediatr Adolesc Gynecol 2006; 19:99-103. [PMID: 16624697 DOI: 10.1016/j.jpag.2006.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Imperforate hymen is most commonly an isolated finding and usually remains asymptomatic until puberty. Rarely, symptoms of imperforate hymen manifest antenatally as well as in the neonatal period, requiring surgical correction for life-threatening consequences. We report a 5-day-old infant with a large hydrometrocolpos causing severe renal compromise and abdominal ascites, successfully surgically treated in the neonatal period. Associated polydactyly suggested McKusick-Kaufman syndrome.
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Affiliation(s)
- A El-Messidi
- Department of Obstetrics and Gynecology, University of Ottawa, Ontario, Canada
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Aygun C, Ozkaya O, Ayyýldýz S, Güngör O, Mutlu B, Küçüködük S. An unusual cause of acute renal failure in a newborn: hydrometrocolpos. Pediatr Nephrol 2006; 21:572-3. [PMID: 16523263 DOI: 10.1007/s00467-006-0022-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Revised: 10/06/2005] [Accepted: 10/17/2005] [Indexed: 10/24/2022]
Abstract
Here we report on an unusual cause of acute renal failure in a newborn: hydrometrocolpos due to imperforate hymen. Hymenotomy resolved all of the laboratory and clinical abnormalities of the patient and the baby was sent home healthy.
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Affiliation(s)
- Canan Aygun
- Department of Neonatology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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