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Mohammed TN, Elgadi A, Nuri GME. A rare cause of amenorrhea: Hematocolpos in a post-cystocele repair patient. Clin Case Rep 2024; 12:e8766. [PMID: 38595964 PMCID: PMC11002097 DOI: 10.1002/ccr3.8766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/17/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024] Open
Abstract
Key Clinical Message Secondary hematocolpos is a rare but serious complication after cystocele repair. This warrants multidisciplinary management (gynecology and urology) to optimize outcomes & minimize iatrogenic risks. Abstract Hematocolpos is the term used for the accumulation of menstrual blood in the vagina. It is most commonly seen in adolescent girls but can also occur in elderly women as a result of gynecological conditions. We present the case of a 48-year-old female who presented with amenorrhea and abdominal pain following surgical repair of a cystocele. Investigation revealed secondary hematocolpos due to surgical trauma. Surgical drainage and correction of the uterus were performed, resulting in immediate pain relief. This case underscores the importance of considering hematocolpos in patients with post-surgical amenorrhea, and further research is needed to better understand its causes, risk factors, and optimal management strategies.
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Affiliation(s)
| | - Ammar Elgadi
- Faculty of MedicineUniversity of KhartoumKhartoumSudan
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2
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Hundarova K, Geraldes F, Águas F, Rodrigues Â. A 13-Year-Old Girl with Caudal Regression Syndrome and Distal Vaginal Atresia: A Case Report. Am J Case Rep 2024; 25:e942748. [PMID: 38374616 PMCID: PMC10896708 DOI: 10.12659/ajcr.942748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/12/2024] [Accepted: 01/03/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Caudal regression syndrome (CRS) is a rare anomaly characterized by maldevelopment of the caudal half of the body and can involve the genitourinary system. This report presents the case of a 13-year-old girl diagnosed with CRS and previously unknown distal vaginal atresia, presenting with monthly pelvic pain. CASE REPORT A 13-year-old pre-menarcheal patient with CRS sought emergency care due to debilitating monthly pelvic pain persisting for 3 months. Pelvic examination revealed the absence of a vaginal opening, and a rectal exam showed a 5-cm large bulge anteriorly, along with a 2-cm fibrous septum in the distal portion of the vagina. Pelvic ultrasound and magnetic resonance imaging confirmed the presence of hematometrocolpus and hematosalpinx on the right adnexa, while the left ovary was not identified. Treatment commenced with fixed analgesia and combined continuous oral contraception. Due to the persistent pain and uncertainty regarding the anatomy of the internal reproductive organs, diagnostic laparoscopy with drainage of the hematocolpus was performed 2 weeks later. Six months later, after multidisciplinary discussion, definitive surgery (pull-through vaginoplasty) was carried out, allowing for emotional preparation for postoperative dilation. One year after the definitive surgery, the patient remains asymptomatic, experiencing regular withdrawal bleeding with no signs of obstruction. CONCLUSIONS Patients with musculoskeletal anomalies should undergo urogenital tract evaluation. Timely identification of distal vaginal atresia is pivotal for devising appropriate treatment and averting complications. During the acute phase, laparoscopic drainage can alleviate symptoms and clarify anatomy, without compromising the success of subsequent definitive surgery.
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Affiliation(s)
- Kristina Hundarova
- Gynecology Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Fernanda Geraldes
- Gynecology Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Fernanda Águas
- Gynecology Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Ângela Rodrigues
- Gynecology Department, Coimbra Hospital and University Center, Coimbra, Portugal
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3
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Sharma P, Shah J, Sokkary N. A case of image-guided hematometrocolpos drainage requiring tissue plasminogen activator in a pediatric patient. J Surg Case Rep 2024; 2024:rjae006. [PMID: 38379535 PMCID: PMC10877313 DOI: 10.1093/jscr/rjae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 02/22/2024] Open
Abstract
Hematometrocolpos (HMC) is a rare disorder that occurs when an anatomical anomaly like imperforate hymen causes menstrual blood to be retained in the uterus and vagina. There is no standard of care established for HMC beyond urgent vaginoplasty which requires a demanding post-operative course that may not be suited for all pediatric patients. This is a case report of successful use of image-guided percutaneous drainage of HMC with tissue plasminogen activator (TPA) followed by vaginoplasty in a 13-year-old female with lower vaginal atresia. Additionally, this case explores the role of menstrual suppression and the need for individualized guidelines. It emphasizes the potential of image-guided percutaneous drainage with TPA as a promising, less-invasive treatment option for pediatric HMC as well as the impact on follow-up surgery.
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Affiliation(s)
- Pareena Sharma
- Department of Medicine, Medical College of Georgia of Augusta University, 1120 15th St, Augusta, GA 30912, United States
| | - Jay Shah
- Department of Radiology, Emory School of Medicine/Children’s Healthcare of Atlanta, James B. Williams Medical Education Building 100 Woodruff Circle Atlanta, GA 30322, United States
| | - Nancy Sokkary
- Department of Obstetrics and Gynecology, Emory School of Medicine/Children’s Healthcare of Atlanta, James B. Williams Medical Education Building 100 Woodruff Circle Atlanta, GA 30322, United States
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4
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Grant A, Carpenter CP, Li B, Kim SJ. Hydrometrocolpos: a Contemporary Review of the Last 5 Years. Curr Urol Rep 2023; 24:601-610. [PMID: 38038828 DOI: 10.1007/s11934-023-01191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to provide a comprehensive overview of hydrometrocolpos, covering disease etiology, pathophysiology, clinical presentation, and diagnostic and management techniques, and known outcomes. RECENT FINDINGS This narrative review presents the literature on hydrometrocolpos in the pediatric population from the past 5 years. We highlight the 69 reported cases of hydrometrocolpos and classify them based on type of obstruction or associated anomaly, discuss new diagnostic algorithms based on imaging, and present novel and underutilized surgical techniques for definitive management. Hydrometrocolpos, a condition characterized by retained fluid causing a distended vagina and uterus in the setting of a distal vaginal outflow obstruction, has a wide range of presentation severity based on the type of obstruction. Whether hydrometrocolpos is due to an isolated condition like imperforate hymen, a complex abnormality like cloacal malformation, or a part of a large congenital syndrome, the mainstay of treatment is decompression of the dilated vagina and surgical correction of the outflow obstruction. Imaging-based diagnostic algorithms and new treatment techniques reported in the literature, as well as longitudinal and patient-reported outcome research, can improve the lives of children affected by this condition.
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Affiliation(s)
- Allison Grant
- Department of Pediatric Urology, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Christina P Carpenter
- Department of Pediatric Urology, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Belinda Li
- Department of Pediatric Urology, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Soo Jeong Kim
- Department of Pediatric Urology, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
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5
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Costantini C, Fati F, Pani E, Beretta F, Bisoffi S, Mazzero G, Negri E, Revetria C, Sadri HR, Ciardini E. Two-balloon epistaxis catheter to ensure vaginal patency in a complex case of vaginoplasty for vaginal agenesis: a case report. Pediatr Med Chir 2023; 45. [PMID: 38010316 DOI: 10.4081/pmc.2023.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/05/2023] [Indexed: 11/29/2023] Open
Abstract
Congenital vaginal atresia is a rare anomaly of the female genital tract. Many vaginoplasty procedures have been described, but the postoperative risk of vaginal stenosis remains a challenge. We report a case of isolated distal vaginal agenesis in a patient with neurological impairment where the use of an "alternative" dilator was needed. An 11-year-old girl with Down syndrome was admitted to the Emergency Department complaining of pelvic pain. The clinical evaluation showed a hard and painful pelvic mass associated with an imperforate hymen. Abdominal ultrasound and pelvic MRI were suggestive for hematometrocolpos and absence of the lower third segment of the vagina. Vaginoscopy confirmed the diagnosis of congenital vaginal agenesis. The patient then underwent a laparoscopic-assisted vaginoplasty. Considering the difficult management of the postoperative period, an epistaxis catheter was used as a vaginal stent and dilator. The use of an epistaxis catheter to provide adequate vaginal patency after vaginoplasty can be an alternative solution especially in those cases where calibrations with dilators are difficult or not tolerated.
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Affiliation(s)
- Chiara Costantini
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento; University of Padua, Department of Women and Child Health, Padua.
| | - Federica Fati
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento; University of Padua, Department of Women and Child Health, Padua.
| | - Elisa Pani
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento.
| | - Fabio Beretta
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento.
| | - Silvia Bisoffi
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento; University of Padua, Department of Women and Child Health, Padua.
| | - Giosuè Mazzero
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento.
| | - Elisa Negri
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento, Italy..
| | - Clara Revetria
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento.
| | - Hamid R Sadri
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento.
| | - Enrico Ciardini
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento.
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Al-Buloushi N, AlBusairi S, Alenezi A, Zahir M. Urinary retention complicated by hematocolpos in an adolescent girl: Case report. Int J Surg Case Rep 2023; 112:108934. [PMID: 37925784 PMCID: PMC10667729 DOI: 10.1016/j.ijscr.2023.108934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/08/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE This case report is intended to present an unusual cause of urinary retention by a congenital vaginal obstruction, such as hematocolpos. Hematocolpos is an obstruction of the menstrual flow due to an anomaly of the genital tract, with imperforate hymen being the most common one. CASE PRESENTATION A 12-year-old female patient, was referred to our emergency department for recurrent abdominal pain lasting approximately 90 days. She presented with intermittent dysuria and supra pubic fullness. Ultrasonography confirmed acute urinary retention and features of hematocolpos [7]. CLINICAL DISCUSSION High index of suspicion is necessary to diagnose and treat such patients promptly. Patients usually present with cyclic pain, primary amenorrhea, incomplete emptying of urine, chronic constipation, back pain and recurrent urinary tract infections. Our patient presented with acute urinary retention. CONCLUSION This case report highlights the importance of early recognition of hematocolpos as a potential cause of cyclic pain, and urinary symptoms. Prompt and accurate diagnosis with the appropriate surgical managements, to resolve their symptoms with successful outcomes.
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7
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Moufawad G, Giannini A, D’Oria O, Laganà AS, Chiantera V, Khazzaka A, Maziad G, Nasr E, Geagea V, Jardali MA, Sleiman Z. Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome: A Systematic Review about Diagnosis and Surgical Management. Gynecol Minim Invasive Ther 2023; 12:123-129. [PMID: 37807996 PMCID: PMC10553600 DOI: 10.4103/gmit.gmit_103_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/03/2022] [Accepted: 11/15/2022] [Indexed: 10/10/2023] Open
Abstract
Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare congenital defect of the Müllerian ducts characterized by uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis. The aim of this systematic review is to summarize the main symptoms and presentation of the OHVIRA syndrome, as well as the different types of management, fertility, and obstetrical outcomes. A comprehensive search was performed in PubMed, EMBASE, SCOPUS, and Web of Science databases since inception to May 1, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. After duplicate records removed, the search strategy retrieved 103 articles. The full texts of 73 articles further were assessed for eligibility, and 44 studies were finally included in the systematic review. The mainstay surgical treatment of OHVIRA syndrome is usually a minimally invasive vaginal approach to remove the septum. Ultrasound-guided hysteroscopic resection and laparoscopic resection of the septum have been described as alternatives. Considering the feasibility of minimally invasive approach for the management of the syndrome, laparotomy should be avoided as much as possible and considered only in selected cases.
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Affiliation(s)
- Graziella Moufawad
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University, Rome, Italy
| | - Ottavia D’Oria
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University, Rome, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Aline Khazzaka
- Department of Obstetrics and Gynaecology, Laboratory of Science and Research, Saint Joseph University, Beirut, Lebanon
| | - Ghida Maziad
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Elena Nasr
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Vanessa Geagea
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Marwa Al Jardali
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Zaki Sleiman
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
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8
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Imai K, Aoyama K, Goto T, Kitaori T, Iguchi T, Sasano H, Hattori T, Sugiura-Ogasawara M, Saitoh S. Hematocolpos due to lower vaginal agenesis in an adolescent girl. Acute Med Surg 2023; 10:e832. [PMID: 36895321 PMCID: PMC9990086 DOI: 10.1002/ams2.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
Background Hematocolpos due to imperforate hymen is an important differential diagnosis of abdominal pain in early adolescent stage. However, hematocolpos due to lower vaginal agenesis must be considered because the management differs. Case Presentation A healthy 11-year-old girl presented with a 2-day left lower abdominal pain history. Her breast development had begun, but she had not reached menarche. Computed tomography showed high absorptive value liquid filling the upper vaginal to uterine cavity, a pale highly absorptive fluid component suggestive of hemorrhagic ascites in the abdominal cavity on both sides of the uterus, and normal bilateral ovaries. Magnetic resonance imaging diagnosed hematocolpos due to lower vaginal agenesis. The blood clot was aspirated with a transabdominal ultrasound-guided transvaginal puncture. Conclusion History-taking, imaging tests, and appropriate collaboration with obstetrician/gynecologist with awareness of secondary sexual characteristics were crucial in this case.
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Affiliation(s)
- Kazunori Imai
- Department of Emergency Medicine Nagoya City University Hospital Nagoya Japan.,Department of Pediatrics and Neonatology Nagoya City University Graduate School of Medical Sciences Nagoya Japan.,Department of Pediatrics Hoshigaoka Maternity Hospital Nagoya Japan
| | - Kohei Aoyama
- Department of Pediatrics and Neonatology Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Takato Goto
- Department of Obstetrics and Gynecology Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Tamao Kitaori
- Department of Obstetrics and Gynecology Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Toshiyuki Iguchi
- Department of Pediatrics Hoshigaoka Maternity Hospital Nagoya Japan
| | - Hiroshi Sasano
- Department of Emergency Medicine Nagoya City University Hospital Nagoya Japan.,Department of Advancing Acute Medicine Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Tomonori Hattori
- Department of Emergency Medicine Nagoya City University Hospital Nagoya Japan.,Department of Advancing Acute Medicine Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Mayumi Sugiura-Ogasawara
- Department of Obstetrics and Gynecology Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology Nagoya City University Graduate School of Medical Sciences Nagoya Japan
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Kim JH, Jin ZW, Abe H, Murakami G, Rodríguez-Vázquez JF, Hinata N. Distal vaginal atresia: a report of a rare type found a late-term fetus and its histological comparison with the normal pelvis. Anat Cell Biol 2022; 55:475-482. [PMID: 36071545 PMCID: PMC9747340 DOI: 10.5115/acb.22.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/24/2022] [Accepted: 07/05/2022] [Indexed: 01/02/2023] Open
Abstract
Solitary distal vaginal atresia is generally caused by a transverse septum or an imperforate hymen. We found a novel type of distal vaginal atresia in a late-term fetus (gestational age approximately 28 weeks) in our histology collection. This fetus had a vaginal vestibule that was closed and covered by a thick subcutaneous tissue beneath the perineal skin in the immediately inferior or superficial side of the imperforate hymen. The uterus, uterine tube, anus, and anal canal had normal development. The urethral rhabdosphincters were well-developed and had a normal topographical relationship with the vagina, but the urethrovaginal sphincter was absent. Thus, vaginal descent seemed to occur normally and form the vestibule. However, the external orifice of the urethra consisted of a highly folded duct with hypertrophied squamous epithelium. Notably, the corpus cavernosum and crus of the clitoris had poor development and were embedded in the subcutaneous tissue, distant from the vestibule. Normally, the cloacal membrane shifts from the bottom of the urogenital sinus to the inferior aspect of the thick and elongated genital tubercle after establishment of the urorectal septum. Therefore, we speculate there was a failure in the transposition of the cloacal membrane caused by decreased elongation of the genital tubercle. The histology of this anomaly strongly suggested that the hymen does not represent a part of the cloacal membrane, but is instead a product that appears during the late recanalization of the distal vagina after vaginal descent. The transverse septum was also likely to form during this recanalization.
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Affiliation(s)
- Ji Hyun Kim
- Department of Anatomy, Jeonbuk National University Medical School, Jeonju, Korea,Corresponding author: Ji Hyun Kim, Department of Anatomy, Jeonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea, E-mail:
| | - Zhe-Wu Jin
- Department of Anatomy, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Hiroshi Abe
- Emeritus professor of Akita University, Akita, Japan
| | - Gen Murakami
- Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan
| | | | - Nobuyuki Hinata
- Department of Urology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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10
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Aziz MA, Zahra F, Razianti ZB C, Kharismawati N, Sutjighassani T, Almira NL, Tjandraprawira KD. Challenges in prenatal diagnosis of foetal anorectal malformation and hydrocolpos - Case report. Ann Med Surg (Lond) 2022; 84:104949. [PMID: 36582906 PMCID: PMC9793165 DOI: 10.1016/j.amsu.2022.104949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/29/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance: Foetal hydrocolpos and anorectal malformation are difficult to diagnose prenatally due to abundance of differential diagnoses. This case report presents the challenges of diagnosing such disorders. Case presentation A G3P2A0 woman came at 32 weeks of pregnancy with a referral for foetal ovarian cyst. Ultrasound revealed a singleton breech pregnancy, estimated foetal weight 3528 g. A septate abdominal cyst measuring 11.31 × 7.17 cm and polyhydramnios were present. Elective caesarean section delivered a female baby weighing 2820 g and measuring 43 cm. Neonatal examination revealed a right lateral suprapubic mass and a rectovestibular fistula. A sinoscopy revealed a suspected hydrocolpos. An abdominal hydrocolpos drainage was performed; a patent urachus and normal bilateral adnexa were present. Clinical discussion Hydrocolpos is a rare congenital disorder due to distal obstruction of various etiologies. It may be mistaken with other pathologies, including fetal ovarian cysts. A genitourinary congenital abnormality may occur in conjunction with other abnormalities, including gastrointestinal tract anomalies. The presence of imperforate anus and/or fistula should alert the clinician of a possible association with VACTERL syndrome. Conclusion Hydrocolpos is a rare congenital genitourinary disorder with various differential diagnoses. Simultaneous presence of other abnormalities is likely, with possible association to other syndromes.
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Affiliation(s)
- Muhammad Alamsyah Aziz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia,Corresponding author.
| | - Fatima Zahra
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Cut Razianti ZB
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Nuniek Kharismawati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Tjut Sutjighassani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Nadia Larastri Almira
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Kevin Dominique Tjandraprawira
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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Chen M, Chang Y, Chao H. Hydrometrocolpos in Infants: Etiologies and Clinical Presentations. Children 2022; 9:219. [PMID: 35204939 PMCID: PMC8870707 DOI: 10.3390/children9020219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 12/03/2022]
Abstract
Hydrometrocolpos (HMC) is a rare condition where fluids or secretions accumulate in the vagina (hydrocolpos) or up to the uterus (hydrometrocolpos). This case series study reports three infants with different etiologies and presentations of HMC and aims to review literature for proper workup upon initial diagnosis. The first neonate antenatally presented with a huge cystic mass. HMC secondary to imperforate hymen was proved, and hymenotomy was performed at 2 days of age. The second participant presented with persistent urogenital sinus and hematopoietic chimerism, possibly due to transfusion from her twin brother via placenta anastomoses. At 2 months of corrected age, she had difficult defecating, and sonogram revealed HMC with normal appearance of uterus and ovaries. Regular follow-ups and surgical reconstruction will be conducted before puberty. The third patient had cloacal malformation and multiple congenital anomalies at birth. Vesicovaginal fistula-related HMC was detected and managed with surgical drainage in the neonate stage. The girl began menstruation with dysmenorrhea at 12 years. The image studies demonstrated hematometrocolpos secondary to left-side hemivaginal septum, uterine didelphy, and ipsilateral renal agenesis, indicating Herlyn–Werner–Wunderlich syndrome. HMC can be diagnosed easily via sonogram. Careful external genitalia examinations help to identify persistent urogenital sinus or cloacal malformation. Occasionally, the HMC may be part of syndrome manifestations or associated with sex chromosome anomalies. Clinicians may conduct surveillance of renal, cardiac, and skeletal systems as well as chromosome study for early diagnosis and management.
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12
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Elwood AD, Girda E. Decompression of hematocolpos caused by acquired obstruction in patient with prior radiation therapy for vaginal cancer. Gynecol Obstet Case Rep 2021; 7:161. [PMID: 36276805 PMCID: PMC9586845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND This report is intended to present a unique patient with acquired vaginal obstruction due to prior radiation therapy and subsequent development of hematocolpos. We present a method of surgical decompression for the hematocolpos as well as this patient's follow-up and prevention of re-epithelialization. CASE One patient was recruited and consented for this case study. Pre-operative evaluation, including examination and imaging, intra-operative findings, and post-operative evaluation were reported in this study. After surgical evaluation and drainage of hematocolpos via incision and drainage, a foley balloon was placed to prevent re-epithelialization. Intra-operative fluid cultures yielded no growth. At her follow-up appointment, the foley balloon was removed and the vaginal canal was intact without agglutination or re-accumulation of hematocolpos. CONCLUSIONS This is a unique case of acquired obstruction from radiation therapy causing significant symptomatic hematocolpos. We offer a minimally invasive approach for decompression, evaluation of malignancy, and prevention of re-obstruction. Her post-operative appointment showed resolution of symptoms and patent vaginal canal. Long-term outcomes are still required, including monitoring for malignant recurrence, re-obstruction and stenosis, and sexual health. If re-epithelialization occurs, more definitive therapy will be required, including excision of the vaginal septum or hysterectomy.
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Affiliation(s)
- Adam D Elwood
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ 08901
| | - Eugenia Girda
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ 08901
- Department of Gynecologic Oncology, Cancer Institute of New Jersey, New Brunswick, NJ 08901
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Kurian JJ, Singh Bal H, Kisku S, James Sam C, Kishore R, Arunachalam P, Sen S. An approach to giant neonatal hydrocolpos with normally sited anus - Diagnosis and management including a novel one stage operation. J Pediatr Urol 2021; 17:707.e1-707.e7. [PMID: 34518123 DOI: 10.1016/j.jpurol.2021.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Giant non cloacal neonatal hydrocolpos is a rare entity where early recognition of the underlying cause and drainage of the distended vagina is paramount. Conventionally, immediate management has been by abdominal tube vaginostomy or, in urogenital sinus by vaginal clean intermittent catheterisation (CIC). Though effective in providing temporary relief, the abdominal tube vaginostomy is replete with complications, making it imperative to search for alternatives. Here we describe our method of emergent and definitive management of these children, where definitive repair, depending on the aetiology, has been made possible in a single stage. MATERIAL AND METHODS Seven girls who presented primarily or with history of giant non cloacal neonatal hydrocolpos at two tertiary care centres from January 2013 to March 2021 were studied retrospectively. None had imperforate anus or a bulging hymenal membrane. Four had high vaginal atresia (VA) and three had Urogenital sinus (UGS), one with high confluence. Four girls (2 VA, 2 UGS) presented to us as neonates and were managed by emergency drainage procedures other than tube vaginostomy: CIC in one (low UGS) and a novel abdominoperineal U flap vaginoplasty in three (2 VA, 1 high confluence UGS) which was also the definitive procedure. This procedure involved fashioning an inferiorly based inverted U flap from the posterior wall of distended vagina which is tubularised and flipped down by an abdomino-perineal procedure. The girl with a low UGS later underwent a perineal procedure. Three presented elsewhere as neonates (2 VA, 1 UGS) and had abdominal tube vaginostomy as the emergency drainage procedure. This was complicated by tube dislodgement and pyocolpos till successful reconstruction was performed by us. Successful reconstructions included the abdominoperineal U flap vaginoplasty in one (VA) and a perineal procedure in another (low UGS). One girl with high VA had an inflamed vagina after tube vaginostomy, precluding the U flap vaginoplasty, and underwent abdominal vaginal mobilisation and pull through complicated by partial vaginal necrosis with septic complications. RESULTS Reconstruction resulted in a patent and a good calibre neo-vagina in all at a mean follow up of 48 months. CONCLUSION Immediate management of giant non cloacal neonatal hydrocolpos may either be vaginal CIC or a surgical procedure. The abdomino-perineal U flap vaginoplasty is a one stage neonatal procedure that provides effective drainage and forms a definitive neo-vagina. An abdominal tube vaginostomy can be avoided except where neonatal surgical expertise is unavailable.
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Affiliation(s)
- Jujju Jacob Kurian
- Department of Paediatric Surgery, Christian Medical College, Vellore, 632004, Tamilnadu, India.
| | - Harshjeet Singh Bal
- Department of Paediatric Surgery, Christian Medical College, Vellore, 632004, Tamilnadu, India.
| | - Sundeep Kisku
- Department of Paediatric Surgery, Christian Medical College, Vellore, 632004, Tamilnadu, India.
| | - Cenita James Sam
- PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India.
| | - Ravi Kishore
- Department of Paediatric Surgery, Christian Medical College, Vellore, 632004, Tamilnadu, India.
| | - Pavai Arunachalam
- Department of Paediatric Surgery, PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India.
| | - Sudipta Sen
- Department of Paediatric Surgery, PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India
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