She presented to emergency with severe lower abdominal pain and difficulty to pass urine since morning that day. Initially, the clinician suspected it to be renal or vesical colic pain due to calculi and later suggested an ultrasound abdomen with the pelvis. So can you suggest possibilities?
What about her menstrual history?? Primary amenorrhea with hematometra or hematocolpos due to imperforate hymen can also produce such similar symptoms, from Gynaecological point of view.
what are the ultrasound finding? Please update with the report!
On performing ultrasound we found a hypoechoeic mass in the lower end of vaginal vault.
Both the ovaries and uterus were normal.
The urinary bladder was overdistended .
We kept the first differential as a hematoma because of its appearance .
Second one as a penduculated fibroid which is usual at that age .
Next day morning keeping in mind of hematoma our obgy mam has evacuated the hematoma after viewing it on per vaginal examination . There was an immediate relief in her pain
Ohki...So definitely this was a case of Imperforate hymen right? By hemoatoma you meant collection in the vagina right.
She wouldn't have had her periods at all yet! That what I was asking about her menstrual history. So when there is primary amenorrhea with such kind of history, one should always consider this possibility when a girl presents with urinary retention. Once the hematocolpos is drained, the urinary retention is relieved. History of cyclical pain abdomen can give a clue that she may be having this form of mullerian anomalies.
I would need more information regarding her menstrual cycle as it could probably be primary amenorrhea with heamocolpos, or if she is menstruation then could be a fibroid ( peducnulated one probably) causing pain or multiple fibroid causing urinary obstruction. I would also like to know her clinical exam findings which will help.in making clear picture and would also like to rule out renal tract pathologies
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