Huge Abdominal Mass With Hematocolpometra Due to Imperforate Hymen: An Unusual Clinical Presentation

Abstract

The imperforated hymen is one of the commonest genital tract malformations usually present with cyclic abdominal pain and an obstructive pelvic mass at post-pubertal age. The unusual pre­sentations are delayed menarche with obstructive symptoms rarely acute retention of urine, te­nesmus, and constipation. We report an unusual case of 12- year old girl with a huge mass in the lower abdomen examination revealed imperforate hymen at early pubertal age.
 Further investigation of Magnetic Resonance Imaging (MRI) confirmed hematocolpometra. Then, she underwent simple hymenotomy and drainage of collected menstrual blood from the genital tract. She recovered well during the postoperative periods. We conformed normal menstrual flow at her first follow-up. In conclusion, Imperforate hymen at peripubertal age with an unusual huge abdominopelvic mass concerns further imaging to assure the best outcome.

CryptoImperforate Hymen with a Huge Abdominal Mass and Massive Hematocolpometra in a 15-Year-Old Girlmenorrhea with a Huge Abdominal Mass and Massive Hematocolpometra in a 15-Year-Old Girl

“…However, despite how huge the abdominal mass in the patient was she had no obstructive gastrointestinal symptoms (2,4). Abdominopelvic ultrasonography is the diagnostic tool of choice (1,3,4) at the emergency department with magnetic resonance imaging (MRI) serving as an important diagnostic tool for the detection of other possible associated abnormalities, therapeutic planning, detection of complications, and follow-up (1,5,6), this was not done in the index case due to financial constraints. The differential diagnosis of imperforate hymen includes other developmental abnormalities of the urogenital sinus and Mullerian ducts like transverse vaginal septum, vaginal atresia, and vaginal agenesis (1,3).…”

“…Failure to diagnose these anomalies early burdens patients with further morbidity since the treatment approach is different (1,3,7). Treatment options include a simple, virginitypreserving (6,8,9) socially acceptable surgical procedure known as hymenotomy which is a cruciate incision on the imperforate hymenal membrane to provide an annular intact hymen (6,8,9). Other options of treatment include hymenectomy which involves the removal of the hymen.…”

“…Some complications such as hymenal reclosure, vaginal adhesion, vaginal adenosis, and the recurrent persistent imperforate hymen can be noted in some patients following the surgical opening of the hymen (1, 3, 5) but these were not noted in this case during the follow-up. It is worth noting that the lack of early detection, diagnosis and treatment can lead to long-term complications such as endometriosis, subfertility, infections, hydronephrosis, and renal failure (3,4,5,6).…”

“…It is often diagnosed in adolescent girls (mean age of diagnosis 10.7 ± 4.7 years) after the onset of the menstrual cycle with the majority presenting with amenorrhea (1,2,3,4), lower abdominal pain (about 50% of cases) (1,2,3,4), abdominal mass causing obstructive symptoms (2,5) such as urinary retention, constipation, urinary tracts infections with a smaller percentage also leading to hydroureter, hydronephrosis, and renal failure (1,3,4,5). In utero and newborns (3,4,6), the maternal estrogen effect can predispose to abdominal mass in the female neonate in the form of secretion leading to hydrocolpos (3,4,6) and hydrometrocolpos (3,4,6). In utero diagnosis is made using prenatal ultrasound (4).…”

“…Most cases of imperforate hymen are noted to be either familial or sporadic (1,2,3,4) and it could also be a part of a syndrome -McKusick Kaufman Syndrome (polydactyl, congenital heart defect, and genital malformations which could be an imperforate hymen) (1,3). Delayed diagnosis and treatment of imperforate hymen can lead to complications including hydronephrosis, hematosalpinx, obstructive renal failure, peritonitis, and endometriosis (3,4,5,6). This case review is important for clinicians to have a high index of suspicion when presented with cases of abdominal pain or mass in adolescents and young adults.…”