Congenital vaginal obstructions: varied presentation and outcome

Abstract

Congenital obstructing lesions of vagina, hydrometrocolpos, and hematocolpos, present at a variable time during early childhood and adolescence to different medical and surgical specialties. Twenty-six cases presenting over an 18-years period (1987-2005) were divided into three groups; Group A: neonates (6), Group B: adolescents (18), and Group C: adults (2). Common presentations in neonates (Group A) were abdominal mass (5), neonatal sepsis (3), and respiratory distress (2); whereas abdominal pain (18), voiding dysfunctions (13), and backache (7) were prevalent in adolescents (Group B). Adults (Group C) presented with inability to consummate and infertility (2). Four patients received erroneous treatment; exploratory laparotomy (1) and appendectomy (3). Urinary symptoms and associated urinary abnormalities were present in more than 50% of cases, especially those with complex anomalies. Management included excision of imperforate hymen (16) and transverse vaginal septum (8) through perineal (20) and abdominoperineal approach (4). Patients with urogenital sinus (1) and cloacal malformation (1) had staged reconstruction at 2.5 years of age following preliminary vesicostomy and colostomy at birth. On follow up (range 1-15 years; mean 7) more than 60% patients have menstrual irregularity (11), endometriosis (5), and infertility (4). In conclusion, rarity and variable presentation of congenital vaginal obstructions can lead to delayed diagnosis and erroneous management. A high index of suspicion and cross-sectional imaging help in early diagnosis and associated renal anomalies. A comprehensive management is imperative to preserve the reproductive potentials, as significant proportion of patients may experience sexual difficulties, menstrual irregularity, and infertility.

Imperforate hymen: the importance of early diagnosis

“…In these, although there is no obstruction to the menstrual flow passage, its correct evaluation and orientation are important given the impact they can cause in the patient life, such as the inability to insert tampons, difficulty in intercourse and an increased risk of pelvic inflammatory disease. 6,14,15 The imperforate hymen treatment is surgical. Although the hymenectomy can be performed at any age, it should be as early as possible.…”

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

“…IH should be kept in mind when evaluating a girl with urinary retention. It can easily be misdiagnosed as appendicitis or adnexial masses because patients come to the emergency department with nonspecific symptoms such as lower abdominal pain, dysuria, urinary retention, and constipation (5,6). Menstrual history and secondary sexual characteristics should be investigated in such adolescents.…”

A rare case of pyometrocolpos: A consequence of distal vaginal septum

“…Hydrometrocolpos and haematocolpos caused by imperforate hy- Sandhya Mittal, et al Pyometra due to distal vaginal obstruction men or distal vaginal atresia present with recurrent urinary tract infection, abdominal mass and sometimes findings of obstructive uropathy during the neonatal period as seen in our case but the condition often go unrecognised until weeks or months later when they develop the above three hallmarks of the condition. True incidence of these anomalies is unknown but is reported to be between 0.1% and 3.8% [4]. The incidence of hydrometrocolpos is 1 in 16,000 live births [5].…”