Department of Family Medicine, Mike O'Callaghan Military Medical Center, Nellis Air Force Base, 4700 N Las Vegas Blvd, Las Vegas, NV 89191.
Department of Emergency Medicine, University Nevada Las Vegas, 901 Rancho Lane St 135, Las Vegas, NV 89106.
Mil Med. 2020 Dec 30;185(11-12):2171-2172. doi: 10.1093/milmed/usaa166.
We report a case of acute urinary retention in an adolescent female secondary to hematocolpos. A 13-year-old female presented to the emergency department with acute urinary retention and suprapubic abdominal pain for 24 hours. She denied menstruation or sexual history. Bedside bladder ultrasound scan revealed 1.2 L of retained urine and a Foley catheter was placed. A formal renal ultrasound detected a debris-filled structure in the abdomino-pelvic cavity. Follow-up computed tomography of the abdomen and pelvis revealed an 8.5 cm × 9.3 cm × 12.1 cm mass-like structure in the pelvis. No formal pelvic exam was completed and the patient was taken to the operating room for exploratory laparotomy due to concern for large pelvic mass versus tubo-ovarian abscess. However, upon entering the abdominal cavity, no mass was found. At that point, an external genital exam was performed, revealing an imperforate hymen. Hymenotomy resulted in the evacuation of 2.5 L of clotted blood from the vagina and uterus. Hematocolpos resulting in acute urinary retention is exceedingly rare; however, it is an important differential diagnosis that can be ruled in or out by physical exam findings. Although it may be uncomfortable for adolescent patients and physicians, external genital exams should be conducted in young females with acute urinary retention and amenorrhea to evaluate for imperforate hymen. This can ensure appropriate treatment and avoidance of unnecessary invasive procedures.
我们报告了一例因血腔导致的青春期女性急性尿潴留病例。一名 13 岁女性因急性尿潴留和耻骨上腹痛 24 小时就诊于急诊科。她否认有月经或性史。床边膀胱超声扫描显示有 1.2 L 的潴留尿液，并放置了 Foley 导管。正式的肾脏超声检查发现腹部和盆腔内有一个充满碎片的结构。腹部和盆腔的后续计算机断层扫描显示骨盆内有一个 8.5 厘米×9.3 厘米×12.1 厘米的块状结构。由于担心盆腔肿块与输卵管卵巢脓肿相比，未完成正式的盆腔检查，患者被送往手术室进行剖腹探查。然而，进入腹腔后，未发现肿块。此时，进行了外阴检查，发现处女膜未穿孔。处女膜切开术导致阴道和子宫内排出 2.5 升凝血。由于血腔导致的急性尿潴留极为罕见；然而，通过体格检查结果可以排除或确定该疾病。尽管对于青春期患者和医生来说可能会感到不适，但对于有急性尿潴留和闭经的年轻女性，应进行外阴检查以评估处女膜是否未穿孔。这可以确保进行适当的治疗并避免不必要的侵入性手术。
