#MedicalCase
A 16-year-old girl presented with severe lower abdominal pain (Obstetrics and Gynecology)
Mounica Kavikondala., MBBS
Medical Case Details:
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?Discussions
Dr. Kamalpreet Kaur Nagpal
Obstetrician And Gynaecologist
This can be Ovarian Cyst with torsion.
Obstetrician And Gynaecologist
This can be Ovarian Cyst with torsion.
06.Jun, 03:47pm
Dr. Sravanthi Nuthalapati
Obstetrician And Gynaecologist
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!
Obstetrician And Gynaecologist
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!
06.Jun, 03:47pm
Dr. Mounica Kavikondala
Family Physician
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
Family Physician
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
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06.Jun, 04:00pm
Dr. Sravanthi Nuthalapati
Obstetrician And Gynaecologist
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.
Obstetrician And Gynaecologist
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.
▲ 2
06.Jun, 04:07pm
Dr. Mounica Kavikondala
Family Physician
Yeah true there was primary amenorrhea as per history .
We avoided MRI, because we wanted to see if it was a hemotoma which could be evacuated , though the ultrasound findings were not confirmatory .
Family Physician
Yeah true there was primary amenorrhea as per history .
We avoided MRI, because we wanted to see if it was a hemotoma which could be evacuated , though the ultrasound findings were not confirmatory .
06.Jun, 04:12pm
Dr. Sravanthi Nuthalapati
Obstetrician And Gynaecologist
Ohki.. Get her ultrasound to look for any renal anomalies and X ray lumboscaral spine as these are common with mullerian anomalies.
Thank you for the interesting case discussion.
Obstetrician And Gynaecologist
Ohki.. Get her ultrasound to look for any renal anomalies and X ray lumboscaral spine as these are common with mullerian anomalies.
Thank you for the interesting case discussion.
▲ 2
06.Jun, 04:15pm
Dr. Mounica Kavikondala
Family Physician
Yeah thank you
Looking forward to more case discussions
Family Physician
Yeah thank you
Looking forward to more case discussions
06.Jun, 04:18pm
Dr. Nadia Khan
Obstetrician And Gynaecologist
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
Obstetrician And Gynaecologist
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
06.Jun, 05:28pm
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