Abdominal distension resulting from hematocolpos in children: A case report

Imperforate hymen is a clinical condition whose aetiology remains uncertain, but it is frequently implicated as the leading cause of hydrometrocolpos. It arises from incomplete resorption of the hymeneal membrane during embryonic development and its failure to rupture during the perinatal period, with irregular maturation [ 1 ]. Although familial occurrences have been documented, isolated cases generally lack identifiable mutations or genetic markers [ 2 ]. The evaluation of the hymen at birth is crucial, as newborns can have a prominent hymeneal membrane due to mucocolpos. Hematocolpos, on the other hand, is characterised by the accumulation of menstrual blood in the vagina, resulting from various factors that obstruct menstrual blood flow. This condition commonly arises from the combination of menstruation with an imperforate hymen, where the hymen completely covers the vaginal opening, preventing the flow of menstrual blood. Less frequently, hematocolpos may be attributed to uterovaginal malformations, such as complete vaginal diaphragm, partial vaginal atresia, uterus didelphys, or cervical atresia [ 4 ]. Furthermore, it should be noted that hematocolpos may be associated with a rare syndrome known as OHVIRA or Herlyn-Werner-Wunderlich syndrome, which requires specialised management [ 5 ]. In our region, hematocolpos cases are often diagnosed late due to limited access to health facilities and a lack of awareness of congenital gynecologic anomalies. This contributes to delayed treatment and increases the risk of complications such as endometriosis and infertility. Addressing these conditions in a local context highlights the importance of early detection through community education and improved clinical resources. Furthermore, conditions such as imperforate hymen and other benign gynecologic anomalies such as uterine malformations or pelvic masses are often overlooked until symptoms worsen, particularly in rural areas. Local medical practices and cultural factors also play a role in delayed presentations, as families may hesitate to seek medical advice for young girls with gynecologic problems. Further studies focused on these factors could lead to better preventive strategies and management tailored to local needs. The diagnosis of hematocolpos can be delayed, but early diagnosis is crucial to prevent complications such as endometriosis, infection, and infertility [ 4 , 6 ]. Symptoms of hematocolpos are generally present in puberty during the first menstruation with cyclical pelvic pain, primary amenorrhoea or pelvic mass, palpable mass, and vaginal bleeding or discharge [ 4 , 7 ] and, although urinary difficulty is rare, the appearance of urinary retention [ 8 ]. Hematocolpos is rarely diagnosed during the neonatal period. Typically, its diagnosis involves a combination of physical examination, imaging techniques such as ultrasound or MRI, and occasionally genetic tests [ 5 ]. Treatment for hematocolpos involves surgical intervention to relieve obstruction and drain the accumulated menstrual blood. The specific surgical approach depends on the underlying cause of the hematocolpos. For example, in cases of imperforate hymen, a simple hymenectomy may be sufficient, while more complex cases may require reconstructive surgery [ 4 ]. Alternative approaches to managing hematocolpos, in addition to the hymenectomy mentioned in the article, include minimally invasive techniques such as needle aspiration or small incisions to drain the blood, which may be used in milder cases. Additionally, hormonal therapy can be considered to temporarily suppress menstruation until the patient is ready for surgery, although this is less commonly used.

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Written informed consent was obtained from the patient to publish this case report and accompanying images. On request, a copy of the written consent is available for review by the Editor-in-Chief of this journal.

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Mohamed Ali Chaouch.

The most prevalent congenital anomaly of the vagina is imperforate hymen, although it is relatively rare and may be related to other urogenital malformations. Typically, it remains asymptomatic until menarche, when the accumulation of blood in the internal genitalia becomes evident. The diagnosis typically results from a comprehensive patient history and examination, combined with imaging techniques for confirmation while also excluding associated pathologies. A clinical example of a teenage patient with abdominal mass resulting from hematocolpos due to an imperforate hymen is presented.

Hymeneal imperforation is a rare genital malformation often discovered during abdominopelvic emergencies, estimated to be between 0.05 % and 0.1 % [ 1 ]. The diagnosis of hematocolpos can be established through a combination of clinical evaluation and imaging studies. The clinical presentation typically includes pelvic pain, a palpable mass, and primary amenorrhoea. Imaging modalities, such as ultrasound, can confirm the diagnosis by visualising the dilated vagina filled with blood [ 2 ]. This case report, presented according to the SCARE guidelines [ 3 ], aimed to highlight the main characteristics of hematocolpos in children by showing a typical clinical case.

The authors declare no conflict of interest.