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

Abstract

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.

Imperforate hymen and its complications: report of two cases and review of literature

“…13 3. In chronic cases intestinal obstruction leading to constipation (20-27%) 10 and tenesmus 13 also seen. The treatment includes surgical hymenotomy under anaesthesia following catheterisation with an indwelling Foleys catheter to re-establish vaginal outflow.…”

“…8 The function of the hymen is not clear but is thought to include innate immunity as it provides a physical barrier to infections during the prepubertal period when the vaginal immunity is not fully developed. 4 Imperforate hymen is rarely associated with other female genital tract malformations 2,3 although some authors 9,10 have emphasized the need to rule out associated Mullerian malformations. If the hymen is imperforate, mucus and blood from endometrial sloughing accumulate in the vagina which can present during three main stages in life.…”

“…The age of presentation (mean, range) is 12 and 10-15 years respectively according to Lui et al 10 and 13.2 and 11-16 years respectively according to Liang et al 5 The common mode of presentation of imperforate hymen includes-I. Amenorrhea, which may be primary due to accumulation of blood behind the imperforate hymen 3,4,7 or secondary which can occur following spontaneous closure of previously perforate hymen.…”

“…10 A. Acute retention of urine 7,10,12 which is due to pressure on the bladder by the distended uterus causing angulation at the bladder neck and kinking of the urethra 12 and direct pressure on the urethra causing urethral tamponade. Vaginal outflow obstruction which is seen as a bluish bulge at the introitus.…”

Emergency Point-of-Care Ultrasound Diagnosis of Hematocolpometra and Imperforate Hymen in the Pediatric Emergency Department

“…2Y5 Ultrasound is the initial imaging modality of choice to distinguish between various obstructive uterovaginal anomalies 3 ; however, MRI is often performed to better delineate the anatomy and assist in surgical planning. 6,7 In addition to amenorrhea and cyclical abdominal pain, hematocolpometra can also present with symptoms of urinary retention, constipation, and back pain. 4,5,8Y14 When urinary retention is reported, it is important to identify hydronephrosis and avoid complications such as secondary urinary tract infection.…”