Imperforate hymen causing congenital hydrometrocolpos

Abstract

A 3-day-old girl in good health was referred to our department for the evaluation of an abdominal mass detected at birth. Prenatal ultrasound (US) examinations had shown no anomaly. US examination revealed the presence of a hypoechoic and corpusculated cystic formation of about 8 9 5 9 4 cm located in the mid region of the abdomen. The uterus was not visible and the kidneys were normal with no sign of hydronephrosis. The ovaries were normal. Physical examination confirmed US findings revealing the presence of a curved membrane which covered the vaginal opening. Based on these findings, the patient was diagnosed to have hydrometrocolpos. Hymenectomy was performed and about 100 ml of milky fluid was subsequently removed by aspiration. The patient presented no other congenital anomalies and US follow-up showed a normal structure of the uterus.Keywords Imperforate hymen Á Congenital hydrometrocolpos Á Pelvic mass Á Ultrasound Riassunto Una neonata di 3 giorni, in buona salute, è giunta alla nostra osservazione per la valutazione di una massa addominale riscontrata alla nascita. I controlli ecografici prenatali erano negativi. L'esame ecografico ha mostrato la presenza di una formazione cistica a sede mediana ipoecogena corpuscolata di circa 8 9 5 9 4 cm.Non era visibile l'utero; i reni erano normali senza evidenza di idronefrosi. Ovaie normali. L'esame fisico della neonata, confermava il sospetto ecografico mettendo in evidenza la presenza di una membrana bombata che copriva l'introito vaginale sulla base del quale è stata fatta diagnosi di idrometrocolpo. Si è proceduto con un'imenectomia e successiva aspirazione di circa 100 ml di liquido lattescente. Non vi erano altre anomalie congenite presenti e il controllo ecografico successivo ha mostrato regolare struttura dell'utero.

Congenital Hydrometrocolpos in a 2 Months Old Indian Infant Presented as Dysuria: A Case Report

“…Usually it is the distension of both, the vagina and the uterus; the main brunt being borne by the vagina [1]. Congenital hydrometrocolpos is a rare event with an incidence of about 0.006 % in live births [3]. This condition may be caused by congenital malformations of the genital tract such as vaginal atresia, transverse vaginal septum and imperforate hymen.…”

“…This condition may be caused by congenital malformations of the genital tract such as vaginal atresia, transverse vaginal septum and imperforate hymen. The most frequent cause is imperforate hymen which presents as a soft oval mass at the vaginal opening differentiating it from vaginal atresia in which no such mass is visible at the vaginal orifice [3][4][5][6]. Hydrometrocolpos may also be associated with the McKusick-Kaufman syndrome, an autosomal recessive disorder characterized by vaginal atresia with hydrometrocolpos, polydactyly, congenital heart defects and non-immune mediated hydrops fetalis [1].…”

“…Urinary tract obstruction can lead to oligohydramnios antenatally. Sepsis leading to death can occur secondary to either urinary tract infection or rupture and secondary peritonitis [1][2][3]. Urinary stasis and acute renal failure are due to obstructive uropathy by compression [7,8].…”

“…Early diagnosis reduces the incidence of complications [1,7,8]. Differential diagnosis of a perinatally identified abdominal mass includes ovarian cysts, intra-abdominal sacrococcygeal teratoma (type IV), neuroblastoma, mesoblastic nephroma, bowel duplication, genito-urinary anomalies and anterior sacral meningocele [3].…”

“…It may present during the neonatal period or later at puberty as an abdominal mass or obstructive uropathy due to compression of bladder and/or urethra [1,2]. Imperforate hymen and lower atresia of vagina are most common causes of congenital hydrometrocolpos [3]. Most cases reported earlier were stillbirths and were diagnosed only on autopsy [1].…”