evacuation of the hematocolpos. using progressive vaginal dilators may be the treatment of choice for patients
adds little to the evaluation. Patients diagnosed with imperforate hymen and treated with annular hymenotomy between 2009 and 2013 were included in this retrospective cohort study. ... Om operationen utförs då flickan är i puberteten underlättar östrogenet läkningen [14]. Acute urinary retention can subsequently occur due to the pressure e ect imposed on the bladder and urethra [ ]. If an asymptomatic imperforate hymen
and family should be instructed to expect continued drainage of dark, thick old
Ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs) may be
Gynecol 1987 Mar; 69(3 Pt 1): 412-5, Rock JA, Zacur HA, Dlugi AM, et al: Pregnancy success following surgical
inspection of the external genitalia, variations in hymenal anatomy typically
occasionally to the point of the development of intra-abdominal endometriosis
Las anomalías vasculares congénitas pueden constituir auténticas malformaciones o tumores congénitos (tipo hemangioma). Then, she underwent simple hymenotomy and drainage of collected menstrual blood from the genital tract. urogenital sinus, forming the uterovaginal canal and inserting into the
Absence of significant hematocolpos could indicate a secondary source of primary amenor-rhea and be challenging to the clinical diagnosis. [2][3]. All procedures were carried out in a short operative time, without any intraoperative complications. She had not attained menarche but her secondary sexual characters were developed with breast, pubic and axillary hair in tanner stage 4. Se realizan estudios de imagen y exploración física dirigida, diagnosticando himen imperforado. procedure must be predicted and judged. area a few minutes prior to urinating and as needed for soreness. Ecografía post-himenotomía: útero de 12x5x4cm con línea endometrial de 4mm y múltiples colecciones en cavidad abdominal, la mayor de 8cm x 11cm Figura 4. La observación clínica del desarrollo somático y la exploración ginecológica externa suelen ser los únicos actos esenciales y suficientes en el tratamiento de las niñas. 13. A 3- to 6-month course (or longer)
This person is not on ResearchGate, or hasn't claimed this research yet. En este artículo se tratan dos grandes apartados: las anomalías morfológicas (himen, labios menores) y las anomalías estructurales (anomalías vasculares). During the seventh week, the urorectal septum forms to separate the rectum
1 Typically, these are identified in the neonatal period or at the onset of puberty. A
of the suture as small threads. with vaginal agenesis and androgen insensitivity syndrome. Incidence of IH is sometimes accompanied with Bardet-Biedl or McKusick-Kaufman syndromes. Examination showed that she was in urinary retention and an imperforate hymen was found. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? Methods We carried out a review of the literature, available classification systems, and reports of more than 400 cases of congenital malformation; then, we proposed the present preliminary report for a subsequent classification system. Surgical treatment consisted of a hymenotomy in all patients with laparotomy and vaginal opening to the skin in 3 and 2 cases, respectively. gynecologist who specializes in adolescents. ImperforateHymen Causing Hematocolpos and Acute Urinary Retention in a 14-Year-Old Adolescent, İmperfore hymene sekonder oluşan pelvik kitlenin hymen koruyucu cerrahi ile tedavisi, The frequency of imperforate hymen in Northern Italy, Imperforate hymen with bilateral hydronephrosis: An unusual emergency department diagnosis, Herpes simplex virus type 2 infection associated with urinary retention in the absence of genital lesions, Imperforate hymen as a cause of bladder perforation and intestinal obstruction, Imperforate hymen and ruptured hematosalpinx: A case report with a review of the literature, Hydrometrocolpos and polydactyly: A common neonatal presentation of Bardet-Biedl and McKusick-Kaufman syndromes, Backache: A rare diagnosis and unusual complication, Dominant transmission of imperforate hymen, Treatment of imperforate hymen by application of Foley catheter, A case of retention of urine and haematocolpometra, An unusual cause of acute renal failure in a newborn: Hydrometrocolpos, [New prospects of tissue synthesis in plastic surgery]. It is a rare pathology and thus aim was be to report on the clinical, paraclinical, therapeutic and Hydrocolpos and hematocolpos are defined as vaginal retention cervical and vaginal secretions (hydrocolpos), in newborns and infants, or menstrual blood (hematocolpos) unadolescents at puberty. CO2 laser surgery provides several advantages over traditional surgery, as its systematic use in treating pre-invasive, benign, and congenital pathologies of the female lower genital tract reduces patient discomfort, improves short- and long-term outcomes, and optimizes cost-effectiveness. Imperforate hymen is uncommon, occurring in 0.1 % of newborn females. Three affected family members. We present the case of a premenstrual adolescent with an undiagnosed imperforate hymen complaining of increasing abdominal pain. are important components of the physical examination of the female neonate. Abdominal pain (54.2%), urinary retention (20.3%), abnormal menstruation (14.0%), dysuria (9.7%), increased urinary frequency (5.1%), severe presentation of renal failure (n = 5, 2.1%), and urinary tract infection (n = 1, 0.4%) were presented. Themean age was 12.4 daysfor hydrocolpos and 13.83years for hematocolpos ones. address clinicians the possibility of imperforate hymen as a differential diagnosis in acute urinary retention. The unusual presentations are delayed menarche with obstructive symptoms rarely acute retention of urine, tenesmus, and constipation. Methods Differently from imperforated hymen, MH may be asymptomatic until puberty when the women’s quality of life is jeopardized. If the diagnosis is in question (imperforate
Treatment of IH is hymenotomy or hymenectomy. It occurs when the sinovaginal bulb fails to canalize with the rest of the vagina. We proposed a preface for an updatable classification system characterized by simplicity and clarity depending on the embryologic backgrounds, following a logical anatomical hierarchy, integrating clinical significance, addressing the limitations, focused on categories that compromise the reproductive health of adolescent females, and ultimately focused on treatment options. areas of labial adhesions can be managed expectantly. of the normal annular hymenal configuration. imperforate hymen (1.2%) and 2 children with hymenal septa (2.5%). Imperforate Hymen. Discussion: Imperforate hymen is the most common congenital cause of genital tract obstruction with an incidence of one in 1,000 to 2,000 girls. Aim: The hymenal tissue is a membrane formed through the fusion of the paramesonephric ducts and the urogenital sinus which is perforated normally in utero period. apart from delayed menarche and pain . However, this condition is easily missed in the clinic because the first physician visited by the patient rarely takes a detailed gynecologic history or performs appropriate physical examinations. General
The current prevalence of this disorder is not known [1]. We made a diagnosis of an appendiceal mass and the patient underwent an appendectomy. It is caused by a failure of the hymen to perforate during fetal development. or those associated with such symptoms as recurrent UTIs, urinary dribbling, or
The function of the hymen is not so much clear but thought is that, it provides a physical barrier to infections during the prepubertal period when the vaginal immunity is not fully developed. It is found in 1 in 2000 female births. primarily on clinical experience rather than specific outcome reports or
The available treatment options are revised and presented for each subclass whenever feasible. This case reports describes the typical clinical picture of a late diagnosed imperforate hymen. health is more appropriately addressed in this manner. improvements in surgical therapy are not expected. It combined the advantages of uniformity, being based on embryologic backgrounds, and following anatomical, management complexity hierarchies, in addition to being potentially user friendly. Conclusions: Hymen is not an accurate indication of virginity. We report an adolescent girl who presented with an acute exacerbation of a chronic backache of 6 months duration. cells to the genital ridge, while the genital tract itself develops from the müllerian
Introduction: Imperforate Hymen is the most common female genital tract malformation with prevalence of up to 0.1% and can present with wide variety of symptoms, ranging from abdominal pain to urinary retention. Renal anomalies should be ruled out when other müllerian defects of the
The median operation time was 5 min (3-9 min). McCann J, Wells R, Simon M: Genital findings in prepubertal girls selected
It emphasizes that gynecologic examination should be a part of routine physical examination in adolescent females presenting with abdominal mass. Knowledge of the hymen anatomy and its abnormalities is essential to eliminate the misconceptions about it. they reach the caudal end of the mesonephros, where they come toward the
preoperative studies if any underlying medical conditions exist. Familial occurrence is reported, and screening by history or examination of
We suggest that the appearance of the juvenile human hymen is based on 'premature' birth, following which infant helplessness and a subsequent advantage for vaginal protection from external sources of infection allowed natural selection to increase its persistence well into juvenile life. 2nd ed. difficulty with this "rule of thumb" is that the degree of the child's
cycle when persistent insertion is attempted without success and causing pain. correct such a defect; however, in the asymptomatic patient, waiting until
Discussion: Imperforate hymen presents as amenorrhea, recurrent cyclical lower abdominal/pelvic pains, acute urinary retention or palpable lump due to hematometrocolpos. escape diagnosis until the time of menarche. The
Continuous sutures are a series of stitches made with the same thread of suture, and only the first and last are tied. 'Standard' surgical treatment of imperforate hymen involves hymenectomy after a cruciate, plus, or X-shaped hymenotomy incision. Unfortunately, the typical findings at diagnosis include a large collection
On follow-up, the hymen was still open. maintains excellent perineal hygiene and avoids vulvovaginitis. The overlap of BBS and MKKS is a real diagnostic pitfall and its importance has to be stressed, for genetic counselling, for clinical management and follow up, and for molecular approaches. For example, if woman is using tampons although she is a virgin, this is a very simple sign she will not have any problems or she will have minor pain during her first sexual intercourse. This phenomenon may be associated with other anomalies such as genitourinary tract anomalies (renal agenesis) (2) or genetic disorder (ectrodactyly ectodermal dysplasia-clefting syndrome) (3). typical presenting history of an individual with a hymenal band is the ability
hypoestrogenism associated with vigorous physical activity should be considered;
Pelvic ultrasound via
The inheritance of müllerian defects likely is polygenic or
Our case describes a 16-year-old woman with a previously undiagnosed hymenal septum who presented with a retained tampon within the urinary bladder. A midline vertical hymenal incision was performed. ... Hematocolpos can also associate to obstruction of urethra and urinary retention 28 . Case presentation: A 14-year-old presented with lower abdominal pain for 5 months. or intercourse impacts the timing at which she requests such a procedure. Los trastornos congénitos del tracto genital femenino se presentan con una incidencia de1: 10 000–20 000 nacidas vivas, tienen un amplio espectro de manifestaciones clínicas, se describe su detección de manera bimodal, con complicaciones que incluso pueden amenazar con la vida, sin embargo, con un tratamiento oportuno las pacientes pueden tener un buen pronóstico. The patient's psychological, sexual, and reproductive needs should be addressed by a multidisciplinary team both preoperatively and postoperatively. Although usually children remain asymptomatic until menarche, but in rare cases mucus of the vaginal wall do not absorb and will result in hydrocolpos that can cause urinary retention as Rabani reported (1). Foleys catheterization was done to relief her urinary retention. This sometimes presents as a pelvic mass that compresses the bladder causing acute urinary retention. Se interconsulta al servicio de ginecología en un hospital de tercer nivel, donde realiza punción y aspiración de 50 ml del contenido vaginal en forma ambulatoria, difiriéndose el abordaje quirúrgico. tract infections [UTIs]) may result. Imperforate hymen is a rare condition but it is the most frequent obstructive anomaly of the female lower genital As shown in this case and from a review of the literature, these girls often have symptoms for a long time before the diagnosis is made. The rare finding of both a didelphic uterus and imperforate hymen is described in this case. Imperforate hymen is a rare obstructive congenital anomaly of the female genital tract which arises as a result of complete failure of canalisation of the inferior end of the vaginal plate at the junction between the urogenital sinus and the vagina. When there is complete failure to of the inferior end of the vaginal plate to canalize, then diagnosis of imperforate hymen is made. Obstet
anomalies result from abnormal or incomplete embryologic development. A large hydrocolpos was observed in the initial exploration. anesthesia in an operative setting may be required. of ovarian development, and hormonal and endocrinologic function is without
Pathophysiology: The genital tract develops during
... Surgical hymenectomy is the standard treatment of this anomaly and can be done with X, T, cross or crucial incision and resection of excess tissues but sometimes even a vertical incision of hymen may resolve the problem (1. She referred normal menses, but in fact, although regular, bleeding was filiform and was exteriorized only through the right side of the vagina. In either approach, the vaginal epithelium then … Injury to the adjacent urethra, rectum, or bladder is possible if the
Surgical intervention is necessary only in … Imperforate hymen occurs mostly in a sporadic manner, although rare familial cases do occur. led to discussions of the normal hymenal diameter. Hymenotomy resolved all of the laboratory and clinical abnormalities of the patient and the baby was sent home healthy. hymen. surgeon should be prepared to dodge the pressure-driven stream of old blood and
The evaluation and management of vaginal agenesis or androgen insensitivity
ibuprofen or if a fever develops. We report a case of 14 years girl present with cyclical abdominal pain, backache and primary amenorrhoea with huge mass per abdomen. The hymen, which is a mesodermal sheet, should be perforated in the late time of the embryonic period but sometimes it does not happen. The later the diagnosis of imperforate hymen, the higher the risk of complications like haematometra, haematosalpinx, haemoperitoneum and infections such as tubo-ovarian abscesses, peritonitis and endometriosis (retrograde menstruation theory). Both ovaries were of normal size on palpation. She did not have any significant medical and surgical history, and her neurological examinations were all normal. Hymenotomy was performed with a cruciate incision. CONCLUSION: In case of acute severe urinary retention in an adolescent girl, the clinicians should keep in mind that imperforate hymen may be a causative factor and this condition may easily be treated surgically. Key words: Imperforate hymen, Hematocolpos, Urinary retention. In this case, other imaging
The differential diagnosis of an imperforate hymen includes many conditions,
tract. In each case, the hymen was opened via a circular incision from the central of the distended. The occurrence is sporadic, and typically presents at … Orientaciones diagnósticas principales, El himen imperforado como urgencia en ginecología. situation that often is confused with absence of the vagina. because severe pelvic adhesions and extensive intra-abdominal endometriosis may
Imperforate hymen is a rare genital tract anomaly which has an incidence of about in [ ]. It represents an embryological remnant, originating from the urogenital sinus. She presented with delayed menarche; a physician earlier prescribed analgesic and anthelmintic medication for pain management. bulging yellow-gray mass at or beyond the introitus. counterproductive because the examination frequently is difficult. ipsilateral renal agenesis, duplex collecting systems, and other complex
Infiltration of the membrane prior to
PDF | Imperforate hymen is one of the rare causes of primary amenorrhea due to uterovaginal developmental anomaly. modification are not demonstrated. Aspiration or puncture of the mucocolpos or hematocolpos without definitive
This case is presented to Annular incision was done using electrocautery on the hymen whilst sparing the intact hymenal tissue circumferentially at least 5 mm from the base. midline. obstructive anomalies resolves spontaneously and does not cause problems with
The most common age of presentation is around puberty or during newborn period and childhood. Infectious complications to the procedure are
This technique might be a good alternative for patients seeking to preserve virginity after surgery. Post procedure recovery was uneventful and she was able to pass urine with normal stream subsequently. 1 Although the most common age of presentation is around puberty 2,3 diagnosis in utero [4][5][6] and during the new born period and childhood. to carefully define the anatomy. The hymen itself is formed from the proliferation of the
We call attention to a mandatory detailed anamnesis and thorough physical examination to diagnose this anomaly before the puberty, when complications are less frequent and treatment is advisable. Management of imperforate hymen
There were no other significant reproductive or systemic abnormalities in either case. Although the incidence of microperforated hymen (MH) is unclear, this hymenal subocclusive anomaly is considered a rare entity. Topical lidocaine jelly facilitates the examination
Results Among the currently available classifications, the American Fertility Society (AFS) classification system was found to be the most simple, widely accepted, and user friendly. obstructive anomaly of the female genital tract, but estimates of its frequency
suture (eg, 4-0 polyglycolic acid suture). Postoperative period was uneventful. neovagina are operative, such as a McIndoe procedure with the creation of a
Imperforate hymen is an important cause of abdominal pain in female adolescents, which can usually be diagnosed by thorough clinical history and physical examination. After menarche, clinical symptoms will appear such as abdominal pain, chronic constipation, low back pain, acute urinary retention (AUR), UTIs and primary amenorrhea (2). Frequently, vaginal and rectal pressure is
Its prevalence is 0.05%-0.1%. abdominal mass has been described in association with urinary obstruction. Accurate description of the morphology and integrity of the hymen is critical
By the 12th week, the paired müllerian ducts have fused into a single tube (ie,
The
Follow-up care: Schedule a postoperative office visit 1-4
Aunque infrecuentes, deben conocerse y distinguirse unas de otras ya que su evolución y, en consecuencia, su tratamiento difieren entre sí. 4th ed. Imperforate hymen, with an incidence between 0.1% and 0.05%, is the most common obstructive congenital abnormality of the female genital tract. Case description: The patient was a 30-day-old female infant who was referred to the Taleghani Hospital in Gorgan with symptoms of abdominal distension and urinary retention, in 2016. examination under anaesthetic and a small cruciate incision made in the centre of the hymen. ... Imperforate hymen occurs in approximately 1 in 10000 to 1 in 1000 females, although true incidence is difficult to obtain, familial cases have been reported in the literature but are more often sporadic (1)(2)(3). Medical therapy: Medical therapy
Conclusion: Hydronephrosis is a known but rare complication of an imperforate hymen. Aim: Retained blood is evacuated. surgical procedure. Mild cramping may occur as
described. In conclusion, Imperforate hymen at peripubertal age with an unusual huge abdominopelvic mass concerns further imaging to assure the best outcome. of several months. We recorded 11 cases including 5 cases of hydrocolpos and 6 cases of hematocolpos. Philadelphia, Pa: Lippincott-Raven; 1998:303-62. subsequent pain and infertility compared to endometriosis arising spontaneously;
A 12-year-old premenarchal female presented with severe pain that migrated from the epigastrium to the right lower quadrant. If an adolescent girl presents with abdominal pain and voiding dysfunction, a detailed gynecologic history and appropriate physical examinations of the genital introitus should be performed. Background: Imperforate hymen though most common female genital tract malformation, remains an uncommon cause of acute urinary retention and abdominal pain in children. Contraindications: The only contraindications for a surgical
The retrograde menses and endometriosis associated with an
primitive uterovaginal canal). During per urethral catheterization a non-tender lump which used to increase on Valsalva manoeuvre was noted in the perineum. After conservative hymenotomy about 360ml of dark-tan haem (blood) was drained in few minutes. El estudio por imagen hace posible la orientación etiológica. On gynecologic examination, any opening that allows menstrual blood flow was not observed. Results: transrectal route. Alternatively, a cruciate incision along the diagonal diameters of the hymen, rather than anterior to posterior, avoids injury to the urethra directly anteriorly and can be enlarged by removal of excess hymenal tissue. Surgical correction should be definitive. This case highlights the importance of evaluating all family members of affected patients. There is a wide range of hymenal variants which exist and usually become apparent to women during puberty. More typically, a mucocele is not present. Diagnosis has been made in utero with obstetrical ultrasonography. El himen imperforado hace parte de los trastornos más frecuentes del desarrollo de los genitales femeninos, puede tener múltiples manifestaciones clínicas, leves y severas, con una adecuada identificación, se puede brindar un tratamiento oportuno, y evitar secuelas. Ultrasonography is an essential first step in diagnosis, precluding unwise and
The hymen is a membrane located in the vaginal opening at the level of the introitus and is composed of urogenital sinus epithelial connective tissue [1] [2] [3] [4] [5]. However, if patient or parents refuse genital exam evaluation, imaging studies can greatly help with diagnosis. ... Imperforate hymen (IH), although rare, is the most common obstructive congenital anomaly of the female genital tract, with an incidence rate of approximately 1 in 2000 females [1]. Ultrasonography showed it to be hematometrocolpos. Algunas afecciones vulvares no infecciosas y las que afectan al clítoris tienen particularidades pediátricas que no deben ignorarse. Early use of imaging techniques and surgical treatment can prevent the secondary complications of the disorder such as hydronephrosis and sepsis. A Rare Non Urologic Cause for Urinary Retention; Report of 2 Cases, Hymen imperforatus är en diagnos som ofta missas - Risk för långdragna symtom om adekvat undersökning inte genomförs, Mullerian duct anomalies: Towards an adolescent-focused, treatment-based classification system, Virginity-sparing management of hematocolpos with imperforate hymen: case report and literature review, Imperforate hymen mimicking malignancy in adolescence, Imperforated hymen, a rare cause of acute urinary retention: a case report, Huge abdominal mass with hematocolpometra due to imperforate hymen: an unusual clinical presentation. urogenital sinus. Despite the simple diagnosis and treatment of IH, missed or delayed diagnosis is often a clinical problem owing to its low incidence, nonspecific symptoms, or insufficient physical examination. Hereby we preset 2 cases of premenstrual adolescent with urinary retention and bilateral moderate to severe hydroureteronephrosis. Keywords: Imperforate hymen; Hematometra; Hematocolpos; Hymenotomy; Enugu; Nigeria Background Imperforate hymen is a rare congenital malformation of the vagina. They are encouraged if they are patients with imperforate hymens (no opening or a very small opening). sutured to the hymenal ring using interrupted stitches with fine absorbable
The American Fertility Society classification as well as other classification systems had many limitations. confident of the diagnosis and experienced with the definitive surgical
An imperforate hymen is a congenital disorder where a hymen without an opening completely obstructs the vagina. Clearly, this guideline does not apply
Adolescence . in the neonatal stage, when maternal estrogens lead to an elastic hymen;
An important
... 50,51 Basaran et al stated that the imperforate hymen is somewhat thicker than the borders of the normal hymen. It is easily diagnosed by physical examination. configuration to the hymen can be associated with retention of vaginal
Academic medical center. with intermittent abdominal pelvic pain, which can become severe over the course
This case report discusses a rare presentation of a hymenal variant and highlights the importance of understanding the difference in pelvic examinations in children and adolescents when compared with adults and awareness of the different hymenal variants. Outcomes: Hydronephrosis resolved after the operation. This is a rare cause of the retention of urine and the emergency physician should consider this condition in women between the ages of 12 and 18 years presenting with abdominal pain and obscure urinary complaints. the incision with a long-acting local anesthetic (eg, 0.25% bupivacaine)
The aim of this study is to identify the characteristics, clinical presentations, treatment modalities, and outcomes of imperforate hymen patients.
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