Tuboovarian Abscess as Primary Presentation for Imperforate Hymen

Abstract

Objective. Imperforate hymen represents the extreme in the spectrum of hymenal embryological variations. The archetypal presentation in the adolescent patient is that of cyclical abdominopelvic pain in the presence of amenorrhoea. We reported a rare event of imperforate hymen presenting as a cause of tuboovarian abscess (TOA). Case Study. A 14-year-old girl presented to the emergency department complaining of severe left iliac fossa pain. It was her first episode of heavy bleeding per vagina, and she had a history of cyclical pelvic pain. She was clinically unwell, and an external genital examination demonstrated a partially perforated hymen. A transabdominal ultrasound showed grossly dilated serpiginous fallopian tubes. The upper part of the vagina was filled with homogeneous echogenic substance. Magnetic resonance imaging (MRI) demonstrated complex right adnexa mass with bilateral pyo-haemato-salpinges, haematometra, and haematocolpos. In theatre, the imperforate hymen was opened via cruciate incision and blood was drained from the vagina. At laparoscopy, dense purulent material was evacuated prior to an incision and drainage of the persistent right TOA. Conclusion. Ideally identification of imperforate hymen should occur during neonatal examination to prevent symptomatic presentation. Our case highlights the risks of late recognition resulting in the development of sepsis and TOA.

Imperforate Hymen Presenting with Massive Hematometra and Hematocolpos: A Case Report

“…The diagnosis is usually delayed till after puberty when it presents with its complications like delayed menarche, cyclic lower abdominal pain and mass, and bulging vaginal membrane as in miss UG [2]. Constipation, urinary retention and infection, pelvic infection and tubo-ovarian abscess, hematosalpix, and endometrosis are the other reported symptomatic presentations of imperforate hymens when treatments were delayed [3][4][5][6]. Our patient also had occasional constipation and retention of urine.…”

“…Our patient also had occasional constipation and retention of urine. A defect on the hymenal barrier can encourage ascending pelvic infection in the accumulated menstrual blood as pelvic inflammatory disease, and pelvic abscess, and this informed the empirical use of antibiotics in our patient [3][4][5][6][7][8][9]. The diagnosis of imperforate hymen in miss UG was delayed till after menarche when over 1000 mls of menstrual blood had accumulated as hematometra and hematocolpos.…”

“…The occurrence is sporadic, and typically presents at puberty with delayed menarche, cyclic lower abdominal pain and mass, and bulging vaginal membrane at the vaginal introitus that are secondary to the accumulation of menstrual blood as hematocolpos and hematometra above the imperforate hymen [2]. Other reported bizarre modes of presentations of the complications of untreated imperforate hymen include pelvic infection with tubo-ovarian abscess, obstructive acute renal failure, non-urological urine retention, hematosalpinx, peritonitis, endometriosis, mucometrocolpos, constipation, and recurrent urinary tract infection [3][4][5][6]. Clinicians should have high index of suspicision of imperforate hymen for them to make early diagnosis of these bizarre and challenging modes of presentations of the complications of untreated imperforate hymen.…”

Pyocolpometrasalpingitis Due to Imperforate Hymen in a Preschool Child

“…Prezantasyon şekli pelvik kitle olabilmekte ve üriner retansiyon, intestinal obstrüksiyon gibi bası bulguları izlenebilmektedir. 10,11 Olgumuzda, pelvik kitle ön tanısı mevcuttu ve ek olarak ebeveyninden alınan anamnezinde, idrarını zamanla açılı olarak yaptığı öğrenilmiştir. Bu şekilde açılı işeme, genital sistemde koleksiyonların zamanla birikimine bağlı kütle etkisinin üretra yoluna basısına bağlı bir bulgu olarak yorumlanmıştır.…”

İmperfore hymene sekonder oluşan pelvik kitlenin hymen koruyucu cerrahi ile tedavisi

“…Hematokolpos, hematokolpometra olguları sıklıkla izlenmekle birlikte ihmal edilmiş olgularda tubal rüptür ve enfeksiyona bağlı tuboovaryan abse bildirilmiştir (5,6).…”