McCaskill Ashley, Inabinet Chandler Finney, Tomlin Kristl, Burgis Judith
Columbia School of Medicine, University of South Carolina, Columbia, South Carolina.
Palmetto Health Richland, Columbia, South Carolina.
J Emerg Med. 2018 Oct;55(4):e97-e100. doi: 10.1016/j.jemermed.2018.07.011. Epub 2018 Aug 28.
Prepubertal genital bleeding can be caused by a variety of etiologies including trauma, infection, structural, hematologic disorders, precocious puberty, and malignancy. Urethral prolapse can be seen in prepubescent girls due to a relative estrogen deficiency. Urethral prolapse classically presents with urethral mass and vaginal bleeding, often associated with constipation.
A healthy 6-year-old White girl presented to the Pediatric Emergency Department (ED) with vaginal bleeding for 1 day preceded by a few months of constipation. In the ED the patient's physical examination was remarkable for a tender, nonmobile mass at the vaginal introitus. Transabdominal pelvic and renal ultrasounds were unremarkable. The emergency physician's working diagnosis was a vaginal mass concerning for sarcoma botryoides. Pediatric and Adolescent Gynecology (PAG) was consulted. They performed an examination under anesthesia (EUA) with cystoscopy and vaginoscopy. The EUA confirmed a urethral prolapse approximately 2 cm in diameter. The patient was treated with conjugated estrogen vaginal cream. At her 1-month follow-up, the urethral prolapse had resolved. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Performing a proper pelvic examination of a prepubescent girl presenting with vulvovaginal bleeding is crucial to form an accurate diagnosis in the ED setting. By placing the young girl in the frog-leg or knee-chest position and using both lateral and downward traction of the vulva, one can adequately visualize the external genitalia and outer 1/3 of the vagina. This can help streamline diagnosis and avoid unnecessary examinations and anxiety.
青春期前生殖器出血可由多种病因引起，包括创伤、感染、结构异常、血液系统疾病、性早熟和恶性肿瘤。由于相对雌激素缺乏，尿道脱垂可见于青春期前女孩。尿道脱垂典型表现为尿道肿物和阴道出血，常伴有便秘。
一名健康的6岁白人女孩因阴道出血1天就诊于儿科急诊科，此前有几个月的便秘史。在急诊科，患者体格检查发现阴道入口处有一个压痛、固定不动的肿物。经腹盆腔和肾脏超声检查未见异常。急诊医生的初步诊断是怀疑葡萄状肉瘤的阴道肿物。咨询了儿科和青少年妇科（PAG）。他们在麻醉下进行了检查（EUA），包括膀胱镜检查和阴道镜检查。EUA证实为直径约2厘米的尿道脱垂。患者接受了结合雌激素阴道乳膏治疗。在1个月的随访中，尿道脱垂已消退。急诊医生为何应了解此情况？：对出现外阴阴道出血的青春期前女孩进行适当的盆腔检查对于在急诊科环境中形成准确诊断至关重要。将年轻女孩置于蛙腿位或膝胸位，对外阴进行侧向和向下牵引，可以充分观察外生殖器和阴道外1/3。这有助于简化诊断，避免不必要的检查和焦虑。
