Chebil Aicha, Bouchahda Haifa, Nouiji Sabrine, Dahmeni Hela, Chaouch Mohamed Ali, Marzouk Khouloud
Gynecology Department of Tahar Sfar University Hospital, Mahdia, Tunisia.
Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia.
Int J Surg Case Rep. 2024 Nov;124:110414. doi: 10.1016/j.ijscr.2024.110414. Epub 2024 Oct 4.
Hymeneal imperforation is a rare genital malformation often discovered during abdominopelvic emergencies. Hematocolpos typically presents with pelvic pain, a palpable mass, and primary amenorrhoea. The diagnosis is confirmed by clinical evaluation and imaging studies such as ultrasound.
A 13-year-old girl presented a four-week history of abdominal distension and pain, which worsened over time, along with constipation, but without vomiting or fever. Examination revealed stable vital signs and abdominal guarding. A gynecological exam showed an imperforate hymen. Ultrasound identified a hypoechoic fluid collection in the retrovesical area. Hematocolpos was diagnosed and surgical intervention involved opening the hymen and releasing 800 cc of blood. The patient remained stable after the operation and was discharged painless after two days.
Imperforate hymen, resulting from incomplete resorption of the hymeneal membrane during embryonic development, is a common cause of hematocolpos. Symptoms often manifest in menarche, with cyclical pelvic pain and primary amenorrhoea. The diagnosis is based on physical examination and imaging, while early intervention prevents complications such as endometriosis and infertility. Surgical treatment varies from hymenotomy to more complex reconstructive procedures based on the underlying cause.
Although rare, imperforate hymen is the most prevalent congenital anomaly of the vagina, often remaining asymptomatic until menarche. Accurate diagnosis and timely surgical intervention are essential to avoid severe complications. This case highlights the importance of comprehensive clinical evaluation and appropriate imaging in the management of hematocolpos.
处女膜闭锁是一种罕见的生殖器畸形，常在腹盆腔急症时被发现。阴道积血通常表现为盆腔疼痛、可触及肿块及原发性闭经。通过临床评估及超声等影像学检查可确诊。
一名13岁女孩有四周腹胀及疼痛病史，且随时间加重，伴有便秘，但无呕吐或发热。检查显示生命体征平稳，有腹部压痛。妇科检查发现处女膜闭锁。超声检查在膀胱后区域发现低回声液性暗区。诊断为阴道积血，手术干预为切开处女膜并引出800毫升血液。术后患者情况稳定，两天后无痛出院。
处女膜闭锁是由于胚胎发育过程中处女膜膜片吸收不完全所致，是阴道积血的常见原因。症状常出现在初潮时，表现为周期性盆腔疼痛和原发性闭经。诊断基于体格检查和影像学检查，早期干预可预防诸如子宫内膜异位症和不孕等并发症。手术治疗从处女膜切开到基于潜在病因的更复杂重建手术不等。
尽管处女膜闭锁罕见，但它是最常见的先天性阴道异常，通常在初潮前无症状。准确诊断和及时手术干预对于避免严重并发症至关重要。本病例突出了在阴道积血管理中全面临床评估和适当影像学检查的重要性。
