Hematocolpometra Due to an Imperforate Hymen Presenting With Back Pain

Abstract

Received July 13, 2009, from Venizeleion General Hospital, Heraklion, Crete, Greece. Revision requested August 3, 2009. Revised manuscript accepted for publication August 7, 2009. Address correspondence to Eleni E. Drakonaki, MD, PhD, Venizeleion General Hospital, Knossou Avenue, Heraklion, Crete 71107, Greece. E-mail: drakonaki@yahoo.gr 12-year-old presumably premenarchal girl presented to the emergency department with a 48-hour history of abdominal discomfort and back pain radiating to the level of the right scapula and increasing in the supine position. The patient reported no history of sexual activity or vaginal discharge. Her medical history was unremarkable. Abdominal sonography revealed a cystic mass anterior to the urinary bladder measuring 13.7 (long axis) × 5.6 (short axis) × 5.2 (anteroposteriorly) cm and containing echogenic fluid, corresponding to a distended vagina (Figure 1). There was also distention of the uterus caused by fluid and echogenic material contained in the endometrial cavity (Figure 1B). The findings were suggestive of hematocolpometra. Clinical examination of the perineum confirmed the diagnosis by showing the imperforate hymen, which was bulging and protruding from the introitus. Hymenotomy was performed, and the blood was drained from the vagina via a catheter. The patient’s postsurgical course was uneventful, and symptoms resolved completely within 48 hours. Hematocolpometra secondary to an imperforate hymen and retrograde menstruation is a rare entity that should be considered in the differential diagnosis of abdominal or back pain in premenarchal adolescent girls.1–3 As in our case, the clinical presentation can be misleading because it occasionally mimics a pelvic mass4 or presents with constipation and back pain, due to irritation of the sacral plexus or nerve roots,5–7 and urinary retention, due to compressive effects form the distended