A Rare Cause of Abdominal Pain in a Female Adolescent
ESC Congress Library. Bignall J. 05/10/18; 208065; ESC15
Dr. Jenine Bignall
Dr. Jenine Bignall
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Introduction This case describes an adolescent girl with a history of abdominal pain secondary to haematocolpos, from an undiagnosed imperforate hymen. The case highlights the importance of examining the genitalia as part of the gynaecological assessment of adolescent girls presenting with abdominal pain. Case Report A 12 year old pre-menarchal girl presented with a 6-month history of lower abdominal pain associated with vomiting and urinary hesitancy.  On abdominal examination; a smooth, tender, non-pulsatile midline mass was noted extending from the pelvis to the umbilicus. Routine blood analysis revealed:  Haemoglobin 10.6g/dL, Neutrophils 8.5x109/L, and C-Reactive Protein 12.3mg/L. Urinalysis and a urine pregnancy test were both negative.  CT scan findings (Fig 1) confirmed a very large 19.5 x 9.5 x 10 cm cystic mass arising from the pelvis into the lower abdomen. The uterus was distended with blood and markedly anteverted. A diagnosis of haematocolpos secondary to imperforate hymen was confirmed. Soon after diagnosis, the patient underwent a surgical hymenotomy draining 2 Litres of coagulated blood from the vagina and uterus.  She went on to make a full and uneventful recovery. Discussion Although rare, imperforate hymen is one of the commonest obstructive anomalies of the female lower genital tract, affecting 0.1% girls2. Although occasionally detected in the neonatal period, it is often missed and diagnosed during puberty presenting with cryptomenorrhoea in the form of haematocolpos. Conclusion This case highlights the importance of considering haematocolpos secondary to imperforate hymen as a differential diagnosis in pre-menarchal adolescent girls with a history of abdominal pain and a pelvic mass.
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