Late diagnosis of imperforate hymen with hematometrocolpos a
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Imperforate hymen is a female genital abnormality where the hymen completely obstructs the vaginal opening. Its occurrence is relatively rare, with an approximate incidence of 1 in 2000 female births. A 19-year-old female patient, nulliparous and nulligravida, with a long history of evolving and acute abdominopelvic pain. The patient also reported episodic paroxysmal pain.

The patient had normal vital signs, and a low-grade fever with a body temperature of 38°C. A clinical examination showed a severe abdominal distension and an abdominopelvic mass. An abdominal CT scan with contrast revealed an important uterovaginal distension that resulted from the collection of a dense fluid; this is consistent with a hematometrocolpos caused by imperforate hymen. The hematometrocolpos caused a mass effect on the posterior wall of the bladder which lead to a bilateral ureterohydronephrosis in a horseshoe kidney. In addition, a loculated fluid collection in the peritoneal cavity was noted.

With further exploration, we learned of the patient's history of amenorrhea and multiple consultations for cyclic pelvic pain, and a lack of improvement after medical treatment. A gynecological examination showed a membrane completely obstructing the vaginal opening, thus confirming the diagnosis of imperforate hymen. An exploratory laparotomy showed a uterovaginal distension, associated with a bilateral hydrosalpinx. In addition, there was a thick, encapsulated intraperitoneal collection, covered with peritoneum. The collection had a dark brown color.

An aspiration with peritoneal toilet and adhesiolysis, and an incision of the posterior wall of the vagina were performed. A liquid similar to that of the peritoneal fluid was found. A vaginal toilet was completed, followed by a vaginoplasty. The postoperative course was uneventful. At the 5-month follow-up, the patient reported that she had normal menstrual periods, without dysmenorrhea; each cycle lasted for 4 days. A transabdominal ultrasound control was performed, and it showed a complete evacuation of peritoneal, uterine and vaginal cavities.