Hematometra presenting as an acute abdomen in a 13-year-old postmenarchal girl: a case report

Abstract

IntroductionMost underlying diseases for abdominal pain in children are not dangerous. However some require rapid diagnosis and treatment, such as acute ovarian torsion or appendicitis. Since reaching a diagnosis can be difficult, and delayed treatment of potentially dangerous diseases might have significant consequences, exploratory laparoscopy is a diagnostic and therapeutic option for patients who have unclear and potentially hazardous abdominal diseases. Here we describe a case where the anomaly could not be identified using a laparoscopy in an adolescent girl with acute abdomen.Case presentationA 13-year old postmenarchal caucasian female presented with an acute abdomen. Emergency sonography could not exclude ovarian torsion. Accurate diagnosis and treatment were achieved only after an initial laparoscopy followed by a laparotomy and after a magnetic resonance imaging scan a further laparotomy. The underlying disease was hematometra of the right uterine horn in a uterus didelphys in conjunction with an imperforate right cervix.ConclusionThis report demonstrates that the usual approach for patients with acute abdominal pain may not be sufficient in emergency situations.

Acute abdominal pain caused by hematometra in an adolescent female: a case report

“…In one case, multiple diagnostic workups including invasive procedures such as exploratory laparoscopy were conducted prior to the appropriate diagnosis [4]. In another case, the rarity of this medical condition resulted in a delay of intervention and contributed to the patient’s prolonged discomfort [2].…”

A rare case presentation of an anomalous uterus mimicking ovarian tumour

“…2 Klimek P from Switzerland has reported in a 13 year old post menarcheal girl presenting with acute abdominal pain had haematometra of right uterine horn in a uterus didelphys and imperforate right cervix. 3 Bhattacharya from India has reported in a 46 year old lady who presented with irregular periods lower abdominalpain and a palpable firm mass of size 16*10 cm had uterus didelphys and a fibroid on the anterior wall of left uterine horn and a cyst of size 3*2cm on left ovary. 4 Pervaginal exam revealed two cervices and incomplete vaginal septum.…”

Hematometra and Hematocolpos, Secondary to Cervical Canal Occlusion, a Case Report and Review of Literature

“…Imperforate hymen [4] can create primary hematometra or hematocolpos at menarche and is treated with hymenectomy [4]. There are also reports of cases of primary hematometra due to imperforate cervix in postmenarchal girls with didelphys uterus [3,5]. Hemometra can also be acquired by cervical stenosis secondary to surgical procedures of the cervix such as LEEP and conization [2,[6][7][8][9][10], previous cervical radiation therapy [11] or as a complication of endometrial ablation [12].…”

“…Our patient developed hematometra/ hematocolpos due to postoperative cervical stenosis, as explained throughout this report. Ultrasound and MRI are two imaging modalities that can be used in the diagnosis of hematometra [3,5,13]. With ultrasound the uterus can be seen as an enlarged pelvic mass with an echo free lumen due to the presence of blood [14].…”

“…Premenopausal women with hematometra often experience abnormal vaginal bleeding, including dysmenorrhea (pain during menstruation) or amenorrhea (lack of menstruation), while postmenopausal women are more likely to be asymptomatic [1]. Due to the accumulation of blood in the uterus, patients may develop low blood pressure or vasovagal response, as well as acute abdomen in the setting of uterine rupture [3]. When palpated, the uterus will typically feel firm and enlarged [1].…”