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Case Reports
. 2025 May 9;17(5):e83808.
doi: 10.7759/cureus.83808. eCollection 2025 May.

Hematocolpos: Months-Long Mystery Revealed by Point-of-Care Ultrasound

Clara H Kraft  1 , Justine Pagenhardt  2 , Nick Denne  1 , Joseph Minardi  3   3
Affiliations
Case Reports

Hematocolpos: Months-Long Mystery Revealed by Point-of-Care Ultrasound

Clara H Kraft et al. Cureus. .

Abstract

A premenarchal female suffered recurrent abdominal pain for months before presenting to a critical access emergency department (ED), where point-of-care ultrasound (POCUS) finally revealed the underlying diagnosis of hematocolpos associated with imperforate hymen. Imperforate hymen, while rare, can lead to occlusion of the vaginal orifice during menarche, resulting in hematocolpos. Patients with hematocolpos can present with abdominal, low back, or pelvic pain, and delayed diagnosis may result in additional signs and symptoms, including tenesmus, constipation, urinary retention, and a palpable abdominal mass. Due to many potential etiologies of pediatric abdominal pain, attention to history of present illness and physical examination is critical to elucidate uncommon clinical diagnoses. POCUS is a safe, rapid, low-cost modality to evaluate the broad differential in pediatric abdominal pain. Early incorporation of POCUS may decrease diagnostic errors and patient morbidity associated with a delayed or inaccurate diagnosis.

Keywords: delayed diagnosis; hematocolpos; pediatric pain abdomen; pocus (point-of-care ultrasound); ultrasound in emergency medicine.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. WVU IRB Office of Human Research Protections issued approval 2410048388. Acknowledgement of Not Human Subjects Research 10/08/2024 To: Clara Kraft From: WVU Office of Human Research Protections Protocol Type: NHSR/Flex Approval Date: 10/08/2024 Submission Type: Initial Expiration Date: 10/07/2029 Funding: N/A WVU Protocol #: 2410048388 Protocol Title: Hematocolpos: Months-Long Mystery Revealed by Point-of-Care Ultrasound Case Report The federal definition of research includes the designation for a certain classification of research activities and other projects referred to as "Not Human Subjects Research" or NHSR. This designation allows certain research and research-related projects and activities to be excluded from IRB review and approval. For example, an activity might qualify for an NHSR designation under federal regulations because: • The activity does not meet the HHS or FDA federal definition of "research" that requires IRB review, amendments and/or approvals. • The activity meets the HHS or FDA definition of "research," but does not meet the corresponding regulatory definition of "human subject" requiring IRB review, amendments and/or approvals. The West Virginia University Institutional Review Board has determined that your submission of protocol 2410048388 qualifies as "Not Human Subject Research" as provided under federal regulations. This determination was based on the following: • This project has been deemed not human subjects research because as a retrospective case study involving 5 cases or fewer, it is not a systematic investigation and therefore, does not meet the definition of research. Research means a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge. The following documents were reviewed and acknowledged for use as part of this submission. Only the documents listed below may be used in the research. Please access and print the files in the Notes & Attachments section of your approved protocol. • Cureus Case Report Submission for IRB.pdf • HIPAA Waiver.pdf • Data Protection Certificate - Clara Kraft.pdf WVU IRB acknowledgement of protocol 2410048388 will expire on 10/07/2029. Amendments and continuing reviews are not accepted for this type of study. You may continue this study beyond the expiration date if no changes are made to your study that exclude it from NHSR eligibility. If changes are made to your study that exclude it from NHSR eligibility, it is your responsibility to resubmit it to the IRB as a new, initial submission under the appropriate protocol type. The WVU Office of Human Research Protections will be glad to provide assistance to you throughout the research process. Please feel free to contact us by phone, at 304.293.7073 or by email at IRB@mail.wvu.edu. Sincerely, Joseph Malcom, Program Coordinator Phone: 304-293-7073 Fax: 304-293-3098 IORG: 0000194 Email: IRB@mail.wvu.edu FWA: 00005078 Protocol #: 2410048388. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Joseph Minardi declare(s) personal fees from GE Healthcare. Dr. Minardi does consulting for point-of-care ultrasound and is reimbursed for time and travel if necessary. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Transverse pelvis
In this transverse image of the female pelvis, the decompressed bladder is noted anteriorly (frame B arrow) with a large echogenic fluid collection in the lower uterine segment and vaginal canal (frame B circle) representing retained menstrual blood.
Figure 2
Figure 2. Longitudinal pelvis
In this longitudinal image of the female pelvis, the bladder (labeled in frame B) is noted anterior to a large echogenic fluid collection within the lower uterine segment and vaginal canal (labeled in frame B). The lower borders of the uterus and the endometrial canal are noted on the left screen (labeled in frame B).
See this image and copyright information in PMC

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