Two Patients With Hematometrocolpos

Abstract

Hematometrocolpos is a rare condition due to the malformation of the valve and vagina and is generally discovered in adolescence. We encountered two patients with hematometrocolpos. Both patients were eleven years old and consulted a doctor because of lower abdominal pain. They were diagnosed as having twisted ovarian cysts and introduced to our department. Case 1: On laparotomy, the diagnosis was not ovarian cyst but hematometrocolpos. The vaginal orifice was membranously atretic above the hymen and hymenotomy was performed. Case 2: We diagnosed the patient as having hematometrocolpos preoperatively on the basis of findings of examination of the external genitalia and computed tomography, namely, a distended vagina and uterus filled with blood. Transperineal operation revealed lower vaginal agenesis; then, we pulled down the blind-ending vagina and sutured the vestibular mucosa. Both patients started menstruating after the operation.

If an adolescent girl has lower abdominal pain and does not have menarche despite physical development with Tanner stages of II–III, we should perform abdominal ultrasonography. In patients with lower abdominal cystic mass, we should inspect the external genitalia, and if the vaginal orifice is atretic, abdominal computer tomography or magnetic resonance imaging is indicated. Hymenotomy is the treatment of choice in the case of imperforate hymen. On the other hand, in the case of lower vaginal agenesis, we should select primary anastomosis of blind-ending vagina and hymen if possible.