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Case Reports
. 2024 Nov:124:110414.
doi: 10.1016/j.ijscr.2024.110414. Epub 2024 Oct 4.

Abdominal distension resulting from hematocolpos in children: A case report

Aicha Chebil  1 , Haifa Bouchahda  1 , Sabrine Nouiji  1 , Hela Dahmeni  1 , Mohamed Ali Chaouch  2 , Khouloud Marzouk  1
Affiliations
Case Reports

Abdominal distension resulting from hematocolpos in children: A case report

Aicha Chebil et al. Int J Surg Case Rep. 2024 Nov.

Abstract

Introduction: Hymeneal imperforation is a rare genital malformation often discovered during abdominopelvic emergencies. Hematocolpos typically presents with pelvic pain, a palpable mass, and primary amenorrhoea. The diagnosis is confirmed by clinical evaluation and imaging studies such as ultrasound.

Case presentation: A 13-year-old girl presented a four-week history of abdominal distension and pain, which worsened over time, along with constipation, but without vomiting or fever. Examination revealed stable vital signs and abdominal guarding. A gynecological exam showed an imperforate hymen. Ultrasound identified a hypoechoic fluid collection in the retrovesical area. Hematocolpos was diagnosed and surgical intervention involved opening the hymen and releasing 800 cc of blood. The patient remained stable after the operation and was discharged painless after two days.

Discussion: Imperforate hymen, resulting from incomplete resorption of the hymeneal membrane during embryonic development, is a common cause of hematocolpos. Symptoms often manifest in menarche, with cyclical pelvic pain and primary amenorrhoea. The diagnosis is based on physical examination and imaging, while early intervention prevents complications such as endometriosis and infertility. Surgical treatment varies from hymenotomy to more complex reconstructive procedures based on the underlying cause.

Conclusions: Although rare, imperforate hymen is the most prevalent congenital anomaly of the vagina, often remaining asymptomatic until menarche. Accurate diagnosis and timely surgical intervention are essential to avoid severe complications. This case highlights the importance of comprehensive clinical evaluation and appropriate imaging in the management of hematocolpos.

Keywords: Amenorrhea; Case report; Hematocolpos; Imperforate hymen; Pediatric abdominal pain.

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Conflict of interest statement

Declaration of competing interest The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Obstruction of the vaginal orifice by a thin, bluish, and bulging membrane (hymen) in the presence of secondary sexual characteristics.
Fig. 2
Fig. 2
Surpubic ultrasound view of retro-vesical, median, hypoechoic fluid containing a fine echogenic spot (red arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 3
Fig. 3
The vaginal membrane was opened using X-shaped incisions, resulting in a significant discharge of 800 cc of blood.
See this image and copyright information in PMC

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