Acute Urinary Retention due to Hematocolpos. Incidence and Symptoms in Children

Introduction: Imperforate hymen is the most common obstructive anomaly of the female reproductive tract. It must be diagnosed at birth by the paediatrician, if it is not diagnosed and be treated it will presents complications at puberty such as blood collection inside the vaginal cavity (hematocolpos), urinary retention, amenorrhoea and pelvic pain or a risk of secondary endometriosis.

The diagnosis of an imperforate hymen is usually made based purely on the physical exam, although Transabdominal ultrasonography is sufficient for imperforate hymen diagnosis.

Caser Report: A healthy 13 year-old girl , presented to pediatric emergency with a two weeks history of lower right abdominal pain which has recently worsened and caused urinary retention. There was no history of vomiting or a change in bowel habit. On examination, vital signs was normal. Her abdomen was soft with mild tenderness supra-pubically and in the left iliac fossa without organomegaly. Laboratory findings showed normal values. Abdominal ultrasound showed urinary bladder with irregular wall with moderate urinary retention . A small amount of free fluid in the pelvis. A 7X7 cm structure was demonstrated that causes a mass effect on the bladder refers to hematocolpos. The findings were verified by a gynecologist and hematocolpos was diagnosed. The virginal membrane was opened using X-shaped diameters And there was a great outpouring of blood 700 cc. The girl was hemodynamically stable with no active bleeding and was discharged in a stable state.

Conclusion: The clinical manifestation of imperforated hymen is the retention of urine and abdominal pain. In this case differential diagnosis can include urinary tract stones, urinary tract trauma, urinary tract infection, and imperforated hymen should be taken into account.