Abraham Cynthia
Department of Obstetrics and Gynecology, Icahn School of Medicine, Mount Sinai Hospital, New York, New York.
J Emerg Med. 2019 Aug;57(2):238-240. doi: 10.1016/j.jemermed.2019.03.014. Epub 2019 Apr 22.
Acute urinary retention is rare in the pediatric population and is typically caused by an obstructing entity. It may result from hematocolpos caused by imperforate hymen. Imperforate hymen is rare, with an associated incidence of 1 in 2000 people. Nonetheless, in a pediatric age female who presents with urinary retention and who has a history of primary amenorrhea or a history of cyclical pelvic pain an examination of the external genitalia should be performed to rule out this condition.
A 12-year-old girl presented to the emergency department with urinary retention and was discharged with a diagnosis of urinary tract infection. She returned the following day to the emergency department with worsening abdominal pain. A computed tomography scan revealed a fluid-filled vagina measuring 12.5 cm. Her bladder measured 15.4 cm. The patient was taken to the operating room for further evaluation by the consulting gynecologist. At the time of surgery, 1000 mL of urine were evacuated after catheterization. Three hundred milliliters of chocolate-colored fluid, consistent with menstrual blood, were evacuated at time of hymenotomy. Hymenotomy was performed with a cruciate incision. No complications were encountered. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: To date, there have been >40 reported cases of imperforate hymen causing hematocolpos and subsequent urinary retention. However, given the rarity of imperforate hymen, hematocolpos leading to acute urinary retention can still be missed. Untreated urinary retention can lead to a compromise in bladder function and subsequent kidney damage.
急性尿潴留在儿科人群中较为罕见，通常由梗阻性病变引起。它可能由处女膜闭锁导致的阴道积血引起。处女膜闭锁很罕见，相关发病率为两千分之一。尽管如此，对于出现尿潴留且有原发性闭经病史或周期性盆腔疼痛病史的儿科女性患者，应检查其外生殖器以排除这种情况。
一名12岁女孩因尿潴留就诊于急诊科，出院诊断为尿路感染。第二天她因腹痛加重再次返回急诊科。计算机断层扫描显示阴道内有12.5厘米的积液。她的膀胱为15.4厘米。患者被送往手术室由会诊妇科医生进行进一步评估。手术时，导尿后排出了1000毫升尿液。处女膜切开术时排出了300毫升巧克力色液体，与经血相符。采用十字形切口进行了处女膜切开术。未出现并发症。急诊医生为何应知晓此事？：迄今为止，已有超过40例关于处女膜闭锁导致阴道积血及随后尿潴留的报告病例。然而，鉴于处女膜闭锁的罕见性，导致急性尿潴留的阴道积血仍可能被漏诊。未经治疗的尿潴留可能导致膀胱功能受损及随后的肾损伤。
