Imperforate hymen: Varied presentation, new associations, and management

Abstract

Aim:Imperforate hymen is an isolated and sporadic event. The aim of this study was to report varied clinical and management problems of consecutive imperforate hymen in children and to compare the genetic review with literature.Materials and Methods:This is a retrospective analysis of eight consecutive imperforate hymen children admitted during 2010–2015.Results:Among eight girls, two were infants and six were in the adolescent group. Clinical presentations included varied degree of genitourinary obstruction (7) and incidental finding (1). Genetic analysis of imperforate hymen suggested sporadic event (5), associations (2), and syndromic (1). Ultrasound and magnetic resonance imaging revealed the level of obstruction. Hymenectomy was done in neonate (1), adolescent (6), and one has been under observation. Abdominoperineal pull-through was done in concomitant proximal vaginal atresia.Conclusions:Hymen development origin is variable and complex. Imperforate hymen is rarely a part of systemic/genetic anomaly. Genital examination at birth or during puberty is mandatory which often guides the timing of hymenectomy and prevents the sequelae of imperforate hymen. Hymenectomy is ideal during puberty and resolves all genitourinary obstructions.

Sonographic presentation acute hematometra and massive hematocolpos in a pubertal girl: A case report

“…Pelvic ultrasonography showed the (superior part) vagina as an echo-free cylindrical structure (Figures 1 and 3) with protruding fornix, in rare cases hematosalpinx may accompany this type of finding. It can be argued that clinical manifestation of imperforate hymen varies from initial incidental finding to urinary retention, referred bladder pain, urinary tract infection (UTI), primary amenorrhea, recurring constipation and (anterior) protruding hymen [24]. In agreement with the postulation of Schorge et al [30]; cervical stenosis may prove a complication of overt resection to the cervical os, presenting features will depend on the rate of obstruction.…”

Imperforated hymen, a rare cause of acute urinary retention: a case report

“…4 Imperforate hymen is usually an isolated finding, but occasionally is known to occur in syndromes like McKusick-Kaufman syndrome, Bardet-Biedl syndrome, Mullerian dysgenesis syndrome and Peter plus syndrome. 5 Mostly imperforated hymen are incidentally detected during examination but when symptomatic, patients can have varied clinical presentation like primary amenorrhea, lump abdomen due to hydrometrocolpos/hematometra, cyclical lower abdominal pain, tenesmus/constipation, urinary tract infection, obstructive uropathy, acute kidney injury or rarely with urinary retention. 6 Proper history, physical examination in lithotomy position and judicious use of imaging in form of ultrasound, MRI or contrast enhance computer tomography clinches the diagnosis in non-syndromic cases.…”

Virginity-sparing management of hematocolpos with imperforate hymen: case report and literature review

“…14 The clinical presentation of imperforate hymen is varied ranging from an incidental finding, midline lower abdominal mass with or without protruding hymen, urinary retention, urinary tract infection, acute renal failure, constipation, acute abdomen with paralytic ileus, primary amenorrhea/cyclical abdominal pain and respiratory distress. 15 Most cases are diagnosed after menarche because of accumulation of blood in the vagina (hematocolpos) and the uterus (hematometra). Urological complications have been reported in more than 50% of cases presenting with complex congenital vaginal malformation either in neonates or during puberty.…”

“…Hydrometrocolpos and hematometrocolpos cause acute urinary retention from urethral compression/urethral angulation. 15 The main presentation in the index case was cyclical lower abdominal pain, constipation and acute urinary retention.…”