Abstract
Background: Imperforate hymen is an uncommon obstructive congenital anomaly of the female external reproductive channel due to lack of canalization (lower) vaginal plate between the vaginal and urogenital sinus; with a prevalence rate of less < 0.1%. Hematocolpos / imperforate hymen with heamatometra often presents as a pelvic mass that compresses the urinary bladder causing acute urine retention and pain.
 Case presentation: A 14-year-old presented with lower abdominal pain for 5 months. Patient physical examination revealed normal secondary sexual characteristics with a thickened than normal hymen. She presented with delayed menarche; a physician earlier prescribed analgesic and anthelmintic medication for pain management. After conservative hymenotomy about 360ml of dark-tan haem (blood) was drained in few minutes. Postoperative recovery was uneventful; normal menstruation occurred after 4 weeks. 
 Conclusion: Diagnosis through physical examination and ultrasound requires vigilance and a high degree of suspicion; virginity sparing is a viable treatment option due to social reasons and religious beliefs.
Highlights
Imperforate hymen is an uncommon obstructive congenital anomaly of the female external reproductive channel due to lack of canalization vaginal plate between the vaginal and urogenital sinus; with a prevalence rate of less < 0.1%
There is some controversy on the appropriate period for surgical correction, when imperforate hymen becomes symptomatic with generation of large hematocolpos or hematometrium
Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA) syndrome and imperforate hymen sometimes present with similar features; manifestation in pubertal ‘teen’ age, or ultrasonic diagnosis in-utero in cases of hydrometrocolpos
Summary
Imperforate hymen as a prevalence of less than 0.1% [1] occurring as a result of partial failure canalization lowerend of the vaginal plate [2]. Lower abdominal ultrasound showed a 2.8cm diameter anechoic collection in-utero and at the upper vaginal cavity suggestive of hematocolpos and hematometra. She had a pulse rate of 72 bpm, blood pressure of 112/70 mmHg and afebrile to touch on general examination. The patient’s hymenotomy was conducted under influence of general anesthesia; postoperative sonography revealed a greatly diminished uterine size (Figure 3). Both ovaries were normal in size (anatomically). Hematocolpos and Hematometra (H) in a longitudinal scan 1.2cm left of the pubic symphysis
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