Hydrocolpos causing bowel obstruction in a preterm newborn: a case report

BACKGROUND

Imperforate hymen is the most common congenital defect of the female urogenital tract. The spectrum of clinical manifestations is broad, ranging from mild cases undiagnosed until adolescence to severe cases of giant intraabdominal masses. The most common complication of hydrocolpos is bladder compression, resulting in obstructive uropathy and hydronephrosis.

CASE PRESENTATION

We present here the case of a preterm neonate who was admitted to the surgical neonatal intensive care unit for bowel obstruction. The baby did not appear septic or unwell, a small amount of meconium passed frequently, and no bilious gastric residuals occurred. Based on these findings, acute abdominal obstruction was doubtful, and the surgeon chose a conservative (watch and wait) approach. Subsequently, we performed abdominal ultrasound and magnetic resonance imaging based on unclear information about a suspicious abdominal mass raised by the gynecologist shortly before the emergency C-section. The final diagnosis was congenital hydrocolpos due to imperforate hymen. The pediatric gynecologist indicated an incision of the imperforate hymen under general anesthesia. The incision resolved abdominal distention as well as the bowel obstruction.

CONCLUSION

The presentation of hydrocolpos was not typical (no bulging in the vaginal introitus) in our case, and clinical symptoms implied acute bowel obstruction shortly after birth. The surgeon chose a conservative (watch and wait) approach as the baby did not appear unwell on the second day of life. Fortunately, diagnostic laparotomy was not required as the next step in bowel obstruction management. All clinical symptoms resolved after a minor surgical procedure.

Hydrometrocolpos: a Contemporary Review of the Last 5 Years

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.

Ultrasonographic examination and resolution of a pronounced hematocolpometra linked to an imperforate hymen: A detailed case study

An imperforate hymen is a rare malformation present at birth; however, in most cases, diagnosis is missed until adolescence, when hematocolpometra and its symptoms develop. At this stage, every further delay in diagnosis and treatment will negatively affect the quality of life of young females. It may also be one of the causes of endometriosis and its consequences, such as subfertility. Sonography of the pelvis and physical examination are the diagnostic modalities of choice for diagnosing hematocolpometra and imperforate hymen. We present a case of a 14-year-old patient admitted to the obstetrics and gynecology clinic with complaints of lower abdominal pain and urinary retention following dysuria. The patient was previously examined by a family doctor who misidentified the issue and treated it as a urinary infection. After the symptoms worsened, the patient was referred to a gynecologist. An ultrasound examination showed a distended vagina and uterus, suggesting hematocolpometra, and after further inspection, it was revealed to be caused by an imperforate hymen. A hymenectomy was performed, and about 900 mL of blood was drained. Symptoms and complaints ceased, and the patient was discharged the next day.

A Female Infant with Rectovestibular Fistula and Imperforate Hymen

In a female neonate with anorectal malformation (ARM), the diagnosis is usually simple. But when there are two openings in the introitus and absent anal opening at the normal site, the scenario poses a diagnostic challenge. Careful and detailed evaluation of anomaly is therefore necessary before planning definitive correction. Imperforate hymen, although is not commonly associated with ARM should always be kept in mind as a differential diagnosis and other vaginal anomalies like Mayer-Rokitansky-Küster-Hauser syndrome should be ruled out before definitive surgical correction.

Hematocolpos due to imperforate hymen: a case report and literature systematic review

INTRODUCTION AND HYPOTHESIS

Hematocolpos is a rare condition, where menstrual blood fills the vagina, instead of being expelled, due to a series of uterovaginal pathologies, the most frequent of which is the imperforate hymen. To date, few cases of hematocolpos have been reported in the literature.

METHODS

We report a case of hematometrocolpos due to imperforate hymen initially misdiagnosed as constipation and subsequently as ovarian mass; moreover, the present study undertakes a systematic review of studies on hematometrocolpos due to imperforate hymen to synthesize available knowledge on epidemiology, diagnosis, and management about this rare condition.

RESULTS

A total of 35 studies, describing 61 patients, were identified. The presence of hematocolpos should be suspected in premenarchal patients complaining of low abdominal pain, abdominal swelling, and urinary retention. Genital examination disclosing a tender, pale hymen and ultrasound represent a useful tool for diagnosis. The goal of the management is to timely perform hymenotomy to drain the hematocolpos, followed by hymenectomy to prevent recurrence. Follow-up is needed to diagnose possible recurrences.

CONCLUSIONS

In the case of an adolescent girl complaining of genital pain associated with primary amenorrhea, hematocolpos due to imperforate hymen should be suspected.

Distal vaginal atresia: a report of a rare type found a late-term fetus and its histological comparison with the normal pelvis

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.

Characteristics of fetal physiological and pathological uterine effusion observed on prenatal ultrasonography: a case report

Background

The prenatal detection rate of fetal uterine effusion is very low, and current case reports mainly focus on pathological hydrometrocolpos. We presented two cases of fetal physiological uterine effusion with different ultrasonic characteristics and compared them with one case of hydrometrocolpos with the hope of identifying strategies to reduce misdiagnosis of fetal uterine effusion.

Case presentation

This paper reports the cases of two female fetuses with abnormal pelvic echoes in the third trimester, referred to a tertiary center to be screened for suspected pelvic teratoma and cystic mass, respectively. Ultrasound consultation revealed fetal uterine effusion. The two fetuses were delivered at our hospital after a full term. Re-examining the uterus and adnexa of the neonates revealed that the uterine effusion had subsided naturally. Another female fetus had a large cystic mass in the pelvic cavity in the third trimester, and prenatal examination indicated fetal hydrometrocolpos. The fetus was delivered at our hospital after a full term. The hydrometrocolpos existed even after birth. After consultation with a neonatal surgeon and gynecologist, the newborn was diagnosed with congenital imperforate hymen with hydrometrocolpos. Hymen puncture and open drainage led to a good prognosis.

Conclusions

Prenatal ultrasonography plays an important role in diagnosing and differentiating between physiological and pathological fetal uterine effusion. It can help reduce misdiagnoses that can lead to incorrect clinical decisions.

A rare cause of acute urinary retention in adolescents: A case of imperforate hymen

Imperforate hymen is a genital outflow abnormality that can occur in females. It can present with various symptoms and is associated with short- and long-term complications that may affect patients' quality of life. Acute urinary retention in adolescents is a rare occurrence. We report a case of delayed diagnosis of imperforate hymen involving multiple visits to the clinic for urinary symptoms and the subsequent development of acute urinary retention. Awareness of this rare presentation is essential since delayed diagnosis is associated with hydronephrosis, endometriosis and infertility in later life.

Delayed diagnosis of imperforate hymen with huge hematocolpometra: A case report

BACKGROUND

Imperforate hymen is a rare obstructive anomaly of the female reproductive tract. It is associated with complications, such as cyclical abdominal pain, urinary retention, and pelvic mass.

CASE SUMMARY

A 13-year-old girl presented several times to the emergency room with lower abdominal pain for a year. She received conservative treatment, such as pain control, at each visit. She visited our gynecological clinic for worsening pain, and a 14-cm hematocolpos was found on ultrasonography. She was finally diagnosed with an imperforate hymen with hematocolpometra. Hymenectomy was performed, which resulted in event-free regular cyclical menstruation.

CONCLUSION

Imperforate hymen should be considered in a premenarcheal adolescent girl with periodic abdominal pain.

Congenital anomalies causing hemato/hydrocolpos: imaging findings, treatments, and outcomes

Hemato/hydrocolpos due to congenital urogenital anomalies are rare conditions discovered in neonatal, infant, and adolescent girls. Diagnosis is often missed or delayed owing to its rare incidence and nonspecific symptoms. If early correct diagnosis and treatment cannot be performed, late complications such as tubal adhesion, pelvic endometriosis, and infertility may develop. Congenital urogenital anomalies causing hemato/hydrocolpos are mainly of four types: imperforate hymen, distal vaginal agenesis, transverse vaginal septum, and obstructed hemivagina and ipsilateral renal anomaly, and clinicians should have adequate knowledge about these anomalies. This article aimed to review the diagnosis and treatment of these urogenital anomalies by describing embryology, clinical presentation, imaging findings, surgical management, and postoperative outcomes.

Long-Term Results of an Imperforate Hymen Procedure that Leaves the Hymen Intact

Purpose of the Study

The aim of this study was to show the clinical results of postoperative evaluation of cases of imperforate hymen that presented at our center during a 21-year period.

Methods

A Foley's catheter was inserted in 74 patients of imperforate hymen who reported to the Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, between January 1, 1996, and December 31, 2016 with history of pelvic pain. In each case, the hymen was opened via a circular incision from the central of the distended. A Foley's catheter was inserted, and estrogen cream was prescribed for application on the hymenal structure for 14 days. The catheter was removed after 14 days.

Results

The mean age of the patients at the time of this study was 28.3 ± 2.6 years, and the mean age at diagnosis was 13.2 ± 2.5 years. Twenty-nine (96.6%) patients had experienced vaginal bleeding during their first sexual intercourse experience, and one patient (3.4%) had not. Fourteen out of the 30 married women had become pregnant, of whom nine had delivered vaginally and five had delivered via a cesarean section. After undergoing renal ultrasound, none of the patients had any apparent anomalies. Only one patient had a uterine anomaly, which was a bicornuate uterus.

Conclusion

A circular incision with insertion of Foley's catheter prevents many social problems by preserving the hymen's architecture and allowing vaginal bleeding to occur during the first sexual intercourse experience.

Late diagnosis of imperforate hymen with hematometrocolpos and bilateral hydronephrosis of a horseshoe kidney

Imperforate hymen is a fairly uncommon genital disorder where the hymen completely obstructs the vaginal opening. Several authors have ruled out its co-occurrence with other congenital anomalies. In this report, we discuss the exceptional case of a late diagnosis of imperforate hymen associated with bilateral hydronephrosis of a horseshoe kidney in a 19-year-old female patient. To our knowledge, an association of imperforate hymen and horseshoe kidney has never been reported.

Imperforate hymen and leaking hematosalpinx mimicking acute appendicitis: A report of a rare case and a review of literature

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Cases of imperforate hymen (IH) that present with hemoperitoneum mimicking acute appendicitis are rare.

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Diagnosis and management can be a challenge especially in low-resource setting.

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Surgical management of both acute appendicitis and IH can be successful achieved during the same operative session.

Introduction

Cases of imperforate hymen with leaking hematosalpinx into the peritoneum are rare. We present a case of imperforate hymen mimicking acute appendicitis creating diagnostic challenges with a near miss diagnosis.

Case

A 12-year-old premenarchal female presented with severe pain that migrated from the epigastrium to the right lower quadrant. Physical examination revealed an ill-defined non-tender mass in the right lower quadrant on deep palpation, without signs of peritonitis. We made a diagnosis of an appendiceal mass and the patient underwent an appendectomy. We found approximately 200 mL of dark blood in the peritoneum and an inflamed appendix. After the appendectomy we noticed an engorged right fallopian tube leaking into the peritoneum and a bulky pelvic mass in the lower segment of the uterus. Perineal examination revealed a slightly bulging imperforate hymen. Hymenectomy was performed and 500 mL of viscous old blood was drained. On follow-up, the hymen was still open.

Discussion

Imperforate hymen commonly presents with cyclic abdominal pain and enlarging mass in premenarchal females, it is rare to present with hemoperitoneum and mimicking acute appendicitis.

Conclusion

Although rare, imperforate hymen with retrograde menstruation that causes dilatation of the vagina and uterus (i.e., hematocolpometra) is an important consideration in the differential diagnosis of abdominal pain in premenarchal females with abdominal pain. It is easily diagnosed by physical examination. However, if patient or parents refuse genital exam evaluation, imaging studies can greatly help with diagnosis. Ultrasound will show an echogenic fluid accumulation in the vagina that can extend to uterus.

Vaginal reconstruction for distal vaginal atresia without anorectal malformation: is the approach different?

INTRODUCTION

Distal vaginal atresia is a rare condition and treatment approaches are varied, usually driven by symptoms.

METHODS

A retrospective review was performed to identify patients with distal vaginal atresia without anorectal malformation. Data collected included age and symptoms at presentation, type and number of operations, and associated anomalies.

RESULTS

Eight patients were identified. Four presented at birth with a hydrocolpos and four presented with hematometrocolpos after 12 years of age. Number of operations per patient ranged from one to seven with an average of three. The vaginal reconstruction was achieved by perineal vaginal mobilization in four patients and abdomino-perineal approach in four patients. One patient, with a proximal vagina approximately 7 cm from the perineum, required partial vaginal replacement with colon. In addition, she had hematometrocolpos with an acute inflammation at the time of reconstruction despite menstrual suppression and drainage which may have contributed to the difficulty in mobilizing the vagina. In five patients, distal vaginal atresia was an isolated anomaly. In the other three cases, associated anomalies included: mild hydronephrosis that improved after hydrocolpos decompression (2), cardiac anomaly (2), and vertebral anomaly (1).

CONCLUSION

In this series, a distended upper vagina/uterus was a common presentation and the time of reconstruction was driven by the presence of symptoms. Drainage of the hydrocolpos/hydrometrocolpos with menstrual suppression in post-pubertal patients, followed by further work-up, and planned reconstruction is a good surgical strategy.

Virginity-sparing management of hematocolpos with imperforate hymen: case report and literature review

Imperforate hymen results from failure of the endoderm of the urogenital sinus to completely canalize and has an incidence of 0.01% to 0.05%. This sometimes presents as a pelvic mass that compresses the bladder causing acute urinary retention. A 13-year-old girl was referred to our department with a history of primary amenorrhea, cyclic lower abdominal pain, abdominal–pelvic mass, constipation and acute urinary retention. She had an ultrasonography misdiagnosis of a huge ovarian mass before referral to our unit. On examination, the vagina was bulging and compressing the rectum. Repeat abdominal ultrasonography confirmed the diagnosis of hematometrocolpos. She underwent X-shaped hymenotomy with a favorable outcome. Diagnosis of imperforate hymen requires high suspicion index. Virginity-sparing surgery constitutes a good treatment option for cultural and religious reasons.

Hydrometrocolpos etiology and management: past beckons the present

Hydrometrocolpos is a rare condition in which the uterus and the vagina are grossly distended with a retained fluid other than pus or blood. It may present during the neonatal period or later at puberty. Most cases reported earlier were stillbirths and were diagnosed only on autopsy. Antenatal diagnosis is now possible with the advent of ultrasound. An early diagnosis and speedy management is the key to survival. Many previous case reports have focused on the varied clinical presentations, multiple causes, associated syndromes and/or the radiological diagnosis of this condition. However, management options for different types of hydrometrocolpos have not yet been concisely discussed. We have reviewed the literature and tried to summarize the management options applicable to most case scenarios of hydrometrocolpos.

Spontaneous Reformation of Imperforate Hymen after Repeated Hymenectomy

BACKGROUND

Imperforate hymen prevents menstrual blood drainage, which causes cyclic lower abdominal pain and amenorrhea. Untreated patients might develop serious complications such as endometriosis and infertility. Hymenectomy represents the adequate treatment.

CASE

In a 16-year-old female virgin presented with recurrent lower abdominal pain, urine retention, and secondary amenorrhea after 3 hymenectomy surgeries. The examination revealed imperforate hymen. A fourth hymenectomy was performed with continuous locked sutures over all of the edges.

SUMMARY AND CONCLUSION

Recurrent imperforate hymen after hymenectomy should be suspected if symptoms recur. Diagnosis can be achieved through meticulous clinical examination and appropriate imaging techniques.

The interdigitating Y-plasty procedure for the correction of transverse vaginal septa

Transverse vaginal septa are rare congenital abnormalities of the female genital tract, the surgical management of which is hardly described in the literature. While thicker septa might require complex reconstructive surgery, this paper proposes a simple technique for the surgical management of thin septa, utilising two interdigitating Y-plasties, without the need for excision of any septal tissue. The authors also present their series of eight consecutive cases where this technique was used, with no major complications or any cases of vaginal re-stenosis. This technique can also be used in imperforate hymen correction, therefore it might also be of interest to the general gynaecologist.

TWEETABLE ABSTRACT

Interdigitating Y-plasties in transverse vaginal septa: presentation of a new technique.

Radiological Diagnosis of Neonatal Hydrometrocolpos- A Case Report

A three-day-old female child presented to us with abdominal distension and lower limb swelling. On ultrasound examination, there was a cystic mass contiguous with the uterus in the lower abdomen and pelvis which showed fluid- debris level. This mass was causing displacement of the urinary bladder anteriorly. MRI confirmed the findings of ultrasound. A diagnosis of hydrometrocolpos secondary to imperforate hymen was made following physical examination. Neonatal hydrometrocolpos is a rare condition which requires a high index of suspicion for diagnosis. Hydrometrocolpos refers to the accumulation of secretions within the endometrial and endovaginal canal. Diagnosis can be made prenatally or post natally using ultrasonography and magnetic resonance imaging. Early diagnosis reduces the incidence of complications.

Unique Case of Imperforate Hymen

BACKGROUND

Imperforate hymen typically presents in adolescence with pain, hematocolpometra and primary amenorrhea. This case documents a previously unreported etiology for an atypical presentation with a history of recent menstruation.

CASE

A female adolescent presented with symptoms of urinary retention and leg pain. She reported a history of irregular, painful menses. Clinical examination revealed a pelvic mass and imperforate hymen. Sonography was consistent with hematocolpometra. Before a planned hymenectomy, the patient began to pass dark blood through a fistulous opening in her vulva. Hymenectomy resulted in complete resolution of the pain and hematocolpometra.

SUMMARY AND CONCLUSION

Identification of the fistulous tract explained the patient's history of menstrual bleeding despite an imperforate hymen. Spontaneous rupture of hematocolpometra through a fistulous tract to the vulva is a previously unreported atypical presentation of imperforate hymen in a "menstruating" adolescent with pain and a pelvic mass.

Imperforate hymen presenting as vaginal cyst in a 16-month-old child - considerations for an early diagnosis

Imperforate hymen is a congenital anomaly of female external genitalia, which is mostly diagnosed in puberty, at the age of 9-13 years, or very rarely at a younger age. Clinical picture varies from abdominal pain and low back pain to acute urinary retention. We describe a case of a 16-month-old female infant where the imperforate hymen presented as a vaginal cyst. The cyst was first observed by the patient's mother, although the child had been examined by a paediatrician on several occasions after birth. Complete workup performed for differential diagnosis, mostly to exclude other reproductive system anomalies, led to the final diagnosis of imperforate hymen. The aim of this report is to emphasise the necessity of thorough examination of genitalia in female newborns in order to avoid possible complications associated with this diagnosis later in life, as well as other, more severe differential diagnostic anomalies.

Treatment of microperforate hymen with serial dilation: a novel approach

BACKGROUND

Microperforate and imperforate hymens are one of the most common causes of vaginal outflow obstruction in the adolescent population. To date, these hymen anomalies are traditionally treated by hymenectomy with a cruciate excision.

CASES(S)

We report 2 cases of adolescent women with a microperforate hymen who were successfully and minimally invasively treated with progressive dilation with Hegar cervical dilators until a number 23 dilator was reached under anesthesia in the OR.

SUMMARY AND CONCLUSION

Minimally invasive treatment of microperforate hymen with the use of progressive cervical dilators may be an alternative technique to the traditional excisional hymenectomy. Our patients reported satisfaction and minimal postoperative pain or scarring at 2 weeks and 6 months after the procedure. This technique can be an additional option for all women, especially those with cultural beliefs in virginity.

Prenatal pelvic MRI: additional clues for assessment of urogenital obstructive anomalies

OBJECTIVE

Ultrasound prenatal evaluation of pelvic cystic mass can be challenging. After having ruled out a cloaca anterior to a large hydrocolpos, it is important to differentiate between combined urogenital anomalies such as urogenital sinus and isolated genital anomalies.

PATIENTS AND METHODS

We reviewed the charts of 13 women referred for a third trimester pelvic MRI for cystic pelvic mass discovered in second trimester ultrasound. We evaluated MRI compared with postnatal surgical findings in order to determine clues for improving prenatal diagnoses.

RESULTS

MRI excluded the diagnosis of cloacal malformation in nine cases with no false negative. Once a cloaca is ruled out, a different signal between the bladder and the hydrocolpos on T2 sequences is in favor of an isolated genital obstruction. In contrast, in case of urogenital sinus, the vagina is filled with a mixture of genital secretions and urine, which gives it an MRI signal similar to the bladder on T2 sequences.

CONCLUSION

Third trimester fetal MRI is an essential exam for characterization of pelvic cystic mass diagnosed by ultrasound. This exam appears valuable for invalidating the diagnosis of cloacal malformation and for differentiating between isolated genital obstruction and urogenital sinus.

Imperforate hymen causing congenital hydrometrocolpos

A 3-day-old girl in good health was referred to our department for the evaluation of an abdominal mass detected at birth. Prenatal ultrasound (US) examinations had shown no anomaly. US examination revealed the presence of a hypoechoic and corpusculated cystic formation of about 8 × 5 × 4 cm located in the mid region of the abdomen. The uterus was not visible and the kidneys were normal with no sign of hydronephrosis. The ovaries were normal. Physical examination confirmed US findings revealing the presence of a curved membrane which covered the vaginal opening. Based on these findings, the patient was diagnosed to have hydrometrocolpos. Hymenectomy was performed and about 100 ml of milky fluid was subsequently removed by aspiration. The patient presented no other congenital anomalies and US follow-up showed a normal structure of the uterus.

Complete imperforate tranverse vaginal septum with septate uterus: A rare anomaly

The isolated, complete, transverse vaginal septum is one of the most infrequent anomalies of the female genital tract, and when it coexists with a septate uterus, it is even rarer. This report describes a case of transverse vaginal septum with septate uterus. A 12-year-old girl sought medical assessment because of severe cyclic lower abdominal cramping and pelvic pain. Local examination revealed a blind vaginal pouch of 2 cm and on rectal examination a tender pelvic mass was noted. Radiological examination showed transverse vaginal septum in the lower vagina with bicornuate uterus. Surgical resection of the vaginal septum was done under laparoscopic guidance. Hysteroscopy revealed presence of uterine septum which was resected by a resectoscope. Post-operative dilatation of vagina was done to prevent restenosis. Laparoscopic guided abdominoperineal approach is better in such a case as multiple mullerian anomalies may coexist with each other.

Imperforate Hymen - a rare cause of acute abdominal pain and tenesmus: case report and review of the literature

Imperforate hymen is a rare condition that presents with amenorrhea, cyclical abdominal pains and urine retention among pubertal girls. A 14 year old girl with imperforate hymen underwent hymenotomy for hematocolpometra, having presented with abdominal pains and tenesmus.