Long-term consequences of misdiagnosed imperforate hymen- a case report

Abstract

Introduction: Imperforate hymen is a rare congenital anomaly with an incidence of 1:1000 to 1:10,000 newborns. The condition includes symptoms such as primary amenorrhea, recurrent cramping ab­dominal pain, urine retention and constipation. It is typically diagnosed in puberty when the second­ary sex characteristics have already been developed. The aim of this case report is to raise awareness about the late complications that often occur when misdiagnosed. Materials and Methods: 36-years old female is presented with a history of primary sterility. In 1997 she was admitted at the emergency room with an acute abdominal pain and abdominal distension. The ultrasound revealed fluid in the abdominal cavity. The patient underwent emergency operation. During the surgery a collection of coagulated blood was discovered in the lower pelvis. The left ova­ry, the left fallopian tube and a part of the right ovary were removed. One month following the sur­gery, the symptoms reoccurred. A gynecological exam revealed imperforate hymen, complicated with hematocolpos, hematometra and hematosalpinx. Hymenectomy and drainage of the menstrual blood were performed. In the following years the patient had a normal menstrual cycle. In 2017 a hystero­salpingography revealed adhesions in the right Fallopian tube. The patient underwent laparoscopic salpingotomia, as part of preparation for her in vitro fertilization. Results: The patient had suffered from primary sterility due to the misdiagnosed imperforate hymen which lead to the need of an in vitro fertilization as an only option. Conclusion: Imperforate hymen should be mostly suspected in pubertal girls, presenting with recur­ring cyclic abdominal pain, without menstrual bleeding. Early diagnosis is important, due to the pos­sibility of developing serious complications-infections, endometriosis, hydronephrosis, renal failure, infertility.