Pyocolpos Complicating Microperforated Hymen : A Case Report

Authors: Areej Alfryjat¹ ,Ismaiel Abu Mahfouz², Lama Al Mehaisen ², Lana Salameh ¹, Fatima Al-Smadi ³, Marah Marahleh³

1- Al Hussain Al Salt New  Hospital  2- Al Balqa Applied University 3-The Specialty Hospital

Introduction

• Micro-perforated hymen (MH) is a very rare partial obstructive congenital hymenal anomaly.
• Patients with MH may present with abdominal-pelvic pain,  recurrent urinary tract infection, urinary retention, recurrent vulvo-vaginitis and purulent vaginal discharge.
• The  diagnosis of MH is likely to be delayed till girls present sometime after puberty with light and irregular menstrual cycles.
• Imperforated hymen (IH)is a rare congenital abnormality of the female genital tract with incidence of 1/1000, resulting from failure of canalisation of the lower part of the vaginal plate.

The case

• A 14-year-old girl, presented to the emergency room with abdominal pain of one week duration, Transabdominal pelvic ultrasound showed a  right adnexal mass 6 X 6.5 cm of mixed echogonicity.
• Based on the clinical picture, which was suggestive of an ovarian torsion, and in light of the complexity of the mass, an urgent lapratomy was performed. The findings showed normal uterus, tubes, and ovaries. Furthermore, a retroperitoneal mass arising from the pouch of Douglas was felt on palpation,  the surgery was concluded.
• pelvic Magnetic resonance imaging was requested which showed a cystic dilatation of the vagina in continuity with the uterus measuring 12 x 6 x 6.7 cm filled with blood suggestive of imperforate hymen.
• Thereafter, Vulval examination showed a MH with minimal amount of pus coming out from a  pinpoint opening in the hymen at 11 o’clock. hymenotomy was performed and 500 mL of pus were drained.
• The patient recovered well and was discharged home

Discussion

• Microperforated hymen is a variant of obstructive hymenal anomalies. It can be asymptomatic until after menarche when the menstrual blood flow is not completely drained.
• external genetalia examination  should be performed, genital inspection may show blood or fluid discharge from a very small opening in the hymen.
• MH if left untreated may lead to recurrent urinary tract infections, urinary retention, metrocolpos, pyocolpos, and pelvic abscess.
• Pyocolpos is a rare condition, only reported in 1 of 30000 birth, resulted from infection of a heamatocolpos, secondary to either IH, MH, or transverse vaginal septum.

Conclusion

The presence of very light periods, in addition recurrent genitourinary symptoms and recurrent lower abdominal pain should raise the suspicion