DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20172367

Imperforate hymen: the importance of early diagnosis

Pedro Vieira Enes, Pedro Brandão, Paula Ramôa, Ana Torgal

Abstract


The imperforate hymen is one of the most common obstructive lesions of the female genital system, with a prevalence from 1: 1000 to 1: 10000. Anomalies of the hymen are due to incomplete degeneration of the hymen central portion. It can be diagnosed at physical examination from birth and treated surgically. The most common clinical presentation is cyclic pelvic abdominal pain, urinary retention and hematocolpos. 12-year-old girl, premenarche who appealed to the Emergency department with abdominal pain and bilateral lumbar irradiation, over 2 weeks of evolution. Physical examination showed abdominal tumefaction in the hypogastric region, painful to palpation and under tension. Gynecological examination revealed an imperforate hymen, protruding from the introitus. Rectal ultrasonography performed at the emergency room showed vaginal distension with a hypoechoic content of 16 cm, larger diameter. Surgical hymenectomy was performed as treatment. On the 58th postoperative day, the patient was asymptomatic.

The authors present a clinical case of imperforate hymen diagnosed at menarche, an anomaly diagnosed increasingly early due to the earlier physical examination that involves observation of the external genitalia of the new-born and the pre-pubertal child.


Keywords


Amenorrhea, Abdominal pain, Haematocolpos, Hymenectomy, Imperforate hymen

Full Text:

PDF

References


Heger AH, Ticson L, Guerra L, et al. Appearance of the genitalia in girls selected for nonabuse: review of hymenal morphology and nonspecifi c fi ndings. J Pediatr Adolesc Gynecol. 2002;15:27-35.

Lacy JA, Hillard PA. Imperforate hymen. Emedicine [updated Feb 24, 2010]. (acedido em Outubro 2012). Disponível em: http://www.emedicine.medscape.com/article/269050 -overview.

The American Fertility Society classifi cations of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49:944.

Puerta-Fonollá AJ. Morphogenesis of the human genital tract. Ital J Anat Embryol. 1998;103:3-15.

Ulfelder H, Robboy SJ. The embryologic development of thehuman vagina. Am J Obstet Gynecol. 1976;126:769-76.

Shaw LM, Jones WA, Brereton RJ. Imperforate hymen and vaginal atresia and their associated anomalies. J R Soc Med. 1983;76:560-6.

Laufer MR, Weisman LE, Torchia MM, Emans SJ, Duryea TK. Gynecologic examination of the newborn and child. UptoDate [updated Fev 24, 2017]. (Acedido em Março 2017). Disponivel em www.uptodate.com

Drutz JE, Duryea TK, Torchia MM. The pediatric physical examination: The perineum. UptoDate [updated Jul 9, 2015] (Acedido em Dezembro 2016). Disponível em www.uptodate.com

Bakos O, Berglund L. Imperforate and ruptured hematosalpinx: a case report with a review of the literature. J Adolec Health. 1999; 24:226-8.

Salvat J, Slamani L. Hématocolpos. J Gynecol Obstet Biol Reprod. 1998;27:396-402.

Herman MI, Saxena AK, Paton EA. Imperforate hymen. Emedicine [updated Oct 2, 2009]. Disponivel em: http://emedicine.medscape.com/article/954252 -overview.

Saravelos SH, Cocksedge KA, Li TC. Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update. 2008;14:415-29.

Liang CC, Chang SD, Soong YK. Long-term follow-up of women who underwent surgical correction for imperforate hymen. Arch Gynecol Obstet. 2003;269:5-8.

Salvat J, Slamani L. Hematocolpos. J Gynecol Obstet Biol Reprod (Paris).1998;27:396-402.

Nazir Z, Rizvi RM, Qureshi RN, Khan ZS, Khan Z. Congenital vaginal obstructions: varied presentation and outcome. Pediatr Surg Int. 2006;22:749-53.