Himen imperforado con hematocolpos. A propósito de un caso

El himen imperforado es una malformación congénita poco frecuente reconocida como la causa más común de hematocolpos. La mayoría de las pacientes con himen imperforado son infradiagnosticadas hasta la manifestación de síntomas obstructivos en la adolescencia. Presentamos el caso de una mujer de 13 años a quien se le diagnosticó de himen imperforado con hematocolpos.

Imperforate hymen is a rare congenital malformation recognized as the most common cause of hematocolpos. Most patients with imperforate hymen are underdiagnosed until the manifestation of obstructive symptoms in adolescence. We present the case of a 13-year-old female diagnosed with imperforate hymen with hematocolpos.

Himen: un epónimo y mito de larga data en terminologia anatomica / Hymen: a long-standing eponym and myth in terminologia anatomica

RESUMEN: En Terminología Anatómica el término himen es identificado con el número 3530. Es un pequeño tejido membranoso que normalmente ocupa una parte de la abertura vaginal externa en la mujer. La pertinencia del término himen ha sido poco abordada en la literatura del campo terminológico anatómico, por tanto, el objetivo del presente trabajo fue analizar este término, verificar su etimología y funcionalidad, y determinar cómo este ha sido considerado en algunos aspectos de orden cultural, clínico y jurídico. El término himen proviene del latín hymen que es préstamo del griego hymḗn ὑμήν que significa membrana. Con el valor general de cualquier membrana fue usado en Grecia desde el siglo V a.C., sin embargo, a través de un fenómeno de especialización latina, a partir de los siglos I y II d.C., el término fue usado con su significado actual. Su origen proviene del nombre del dios griego del matrimonio llamado Himeneo, lo que vincula el término a un epónimo y mito a la vez. Pese a lo anterior, creemos que su conservación en Terminología Anatómica se podría deber a su larga data de uso, aun cuando podrían existir mejores opciones para denominar esta estructura. El himen no presenta una función biológica conocida, sin embargo, ha tenido gran valoración a nivel cultural, clínico y jurídico, en el que el examen físico ha determinado conclusiones sobre la historia sexual de mujeres y niñas aun cuando las evidencias demuestran que no es una prueba precisa o confiable de la actividad sexual.

SUMMARY: In Terminologia Anatomica the term hymen is identified with the number 3530. It is a small membranous tissue that normally occupies a part of the external vaginal opening in women. The relevance of the term hymen has been scarcely addressed in the literature of the anatomical terminology field. Therefore, the objective of this work was to analyze this term, verify its etymology and functionality, and determine how it has been considered in certain cultural clinical and legal aspects. The term hymen comes from the Latin hymen, borrowed from the Greek hymḗn ὑμήν , which means membrane. With the general value of any membrane, it was used in Greece from the 5th century BC, however, through a phenomenon of Latin specialization, from the 1st and 2nd centuries AD, the term was used applying its current meaning. Its origin comes from the name of the Greek god of marriage called Hymenaeus, which links the term to an eponym and a myth at the same time. Despite the above, we believe that its conservation in Terminologia Anatomica could be due to its long history, even though there may be better options to name this structure. The hymen does not have a known biological function, however, it has been highly valued at a cultural, clinical and legal level, in which the physical examination has determined conclusions about the sexual history of women and girls even when the evidence shows that it is not an accurate or reliable proof of sexual activity.

Hidrometrocolpos neonatal: a propósito de un caso de difícil diagnóstico / Neonatal hydrometrocolpos: a clinical case of difficult diagnosis

RESUMEN El diagnóstico de las malformaciones fetales sigue siendo un reto para el ginecoobstetra, a pesar de los avances en medicina fetal y en tecnología ultrasonográfica. El hidrometrocolpos es una dilatación del útero y vagina por el acúmulo de secreciones, producto de una obstrucción genital usualmente asociada a malformaciones congénitas. Presentamos el caso de una recién nacida con hidrometrocolpos congénito, cuya sospecha diagnóstica en los estudios pélvicos fue de quistes de ovario, pero se debía al incremento de una hidronefrosis bilateral. Al nacimiento, se decidió descomprimir quirúrgicamente la vía urinaria, momento en el que se encontró el hidrometrocolpos asociado a himen imperforado.

ABSTRACT The diagnosis of fetal malformations continues to be a challenge for the obstetriciangynecologist, despite advances in fetal medicine and ultrasonographic technology. Hydrometrocolpos is a dilatation of the uterus and vagina due to accumulation of secretions, product of genital obstruction usually associated with congenital malformations. We present the case of a female newborn with congenital hydrometrocolpos, whose diagnostic suspicion in pelvic studies was ovarian cysts, but it was due to the increase of bilateral hydronephrosis. At birth, it was decided to surgically decompress the urinary tract, at which time hydrometrocolpos associated with imperforate hymen was found.

Himen imperforado con hematocolpos. A propósito de un caso / Imperforate hymen with hematocolpos. Apropos of a case

RESUMEN Los defectos en la canalización de la membrana himeneal causan obstrucción del tracto genital femenino. Como consecuencia aparece hematocolpos, resultante de la acumulación y retención de secreciones cervicovaginales -sangre en útero y vagina-, ante la imposibilidad de su evacuación por la presencia de un himen imperforado. Clínicamente aparece masa abdominal, asociada con malformaciones vaginales congénitas. Se presentó el caso de una adolescente de 13 años que refirió retención urinaria, disuria, dolor y masa en hipogastrio, y ausencia de la menarquía a pesar de un desarrollo puberal en estadio Tanner III. Al realizar ultrasonido se constató sangre en el útero, debido a imperforación himeneal que se resolvió mediante himenotomía. La patología de himen imperforado con hematocolpos debe estar entre los posibles planteamientos sindrómicos de aquellas pacientes con cuadros similares; puede diagnosticarse en la Atención Primaria de Salud a partir de una detallada anamnesis y exploración física, aunque la comprobación requiere ecografía (AU).

ABSTRACT The defects in the channeling of the himeneal membrane cause obstruction in the female genital tract. As consequence hematocolpos appears, resulting from the accumulation and retention of cervicovaginal secretions -blood in the uterus and vagina-, due to the impossibility of its evacuation because of the presence of an imperforate hymen. Clinically, abdominal mass appears associated to congenital vaginal malformations. We presented the case of teenager aged 13 years that referred urine retention, dysuria, pain, had a mass in the hypogastrium, and absence of menarche in spite of a Tanner III pubertal development. An ultrasound showed blood in the uterus due to hymeneal imperforation solved through hymenotomy. The pathology of imperforate hymen with hematocolpos should be among the possible syndrome considerations in those patients with the same characteristics; it can be diagnosed in the primary health care from anamnesis and physical exploration, although the verification requires an ultrasound (AU).

Hematocolpos secundario a himen imperforado / Hematocolpos secondary to imperforate hymen

RESUMEN El hematocolpos es la acumulación de sangre menstrual en la vagina, se produce por imperforación del himen o de la parte inferior de la vagina. El himen imperforado es una rara malformación congénita que ocurre en el 0,1 % de los recién nacidos del sexo femenino; este es un trastorno del desarrollo embriológico del himen que carece del orificio central por el que drenan las secreciones cervicales y uterinas. Se presentó una paciente de 15 años de edad, con antecedentes de haber nacido de parto eutócico a término, con dolor en bajo vientre y en la parte baja de la espalda hacia el lado derecho. El dolor abdominal es la forma de presentación clínica más frecuente de esta afección. El diagnóstico es clínico y se apoya en exámenes complementarios (ultrasonido abdominal y ginecológico). Esta afección se resuelve con la realización de una himenectomía.

ABSTRACT Hematocolpos is the accumulation of menstrual blood in the vagina; it is produced by imperforation of the hymen or the lower part of the vagina. Imperforate hymen is a rare congenital malformation that occurs in 0.1% of female newborns; this is an embryological developmental disorder of the hymen that lacks the central orifice through which uterine and cervical secretions drain. We present a 15-year-old patient with a history of having been born from eutocic delivery at term, pain in lower abdomen and in lower back towards the right side. Abdominal pain is the most common clinical presentation of this condition. Its diagnosis is clinical and is supported by complementary tests (abdominal and gynecological ultrasound). This condition is resolved by means of a hymenectomy.

Diagnóstico y manejo de Himen Imperforado en una lactante menor / Diagnosis and management of Imperforated Hymen in an infant

INTRODUCCIÓN: El himen imperforado es la malformación congénita más frecuente del tracto genital femenino. La mayoría de los casos no se pesquisan en la infancia, debido a un examen genital insuficiente. Su diagnóstico y resolución deben ser precoces y definitivas para evitar complicaciones posteriores. OBJETIVO: Presentar el caso de una lactante portadora de himen imperforado, y actualizar la información sobre las técnicas de examen genital para detectar esta patología en forma precoz y su tratamiento. CASO CLÍNICO: Lactante de 3 meses, consultó por aumento de volumen protruyente en la zona del introito. En el examen físico se realizó maniobra de valsalva que dio salida a una masa homogénea, nacarada de superficie lisa, entre los labios mayores, sugerente himen imperforado. Se complementó el estudio con ultrasonido ginecológico, el que demostró la presencia de hidrocolpos, descartando otras anomalías. Se realizó una himenotomía, que dio salida a abundante material seroso, sin mal olor, y luego se completó la himenectomía mediante la resección de la membrana himeneal. En control al 4to mes posterior a la intervención se constató un himen ampliamente permeable. CONCLUSIÓN: Los equipos de atención neonatal, requieren capacitación acerca de la técnica correcta del examen genital externo de la recién nacida y lactante. La himenectomía es la técnica que permite resolver definitiva mente el cuadro evitando complicaciones.

INTRODUCTION: Imperforated hymen is the most frequent congenital malformation of the female genital tract. Most cases are not investigated in childhood, due to an insufficient genital examination. Its diagnosis and resolution must be early and definitive to avoid subsequent complications. OBJECTIVE: A clinical case of an infant with imperforated himen is presented. To update on genital examination technique necessary to detect this pathology in the newborn and infants, and the proper treatment. CLINICAL CASE: 3-months-old infant that consulted due to an increase in bulging volume in the introitus area. In the physical examination, the Valsalva's maneuver was performed allowed the ex pulsion of a homogeneous pearly mass with a smooth surface, between the labia majora, suggesting imperforate hymen. The study was complemented with gynecological ultrasound, which demons trated the presence of hydrocolpos, ruling out other anomalies. A hymenotomy was performed, which allowed for the evacuation of abundant serous material, with no bad smell, and then the hymenectomy was completed by resection of the hymenal membrane. In follow-up monitoring 4 months after the intervention, a widely permeable hymen was found. CONCLUSION: Neonatal care teams require training on the correct technique of external genital examination of the newborn and infant. Hymenectomy is the technique that allows definitely resolving the condition, avoiding complications.

Himen imperforado y hematocolpos por retención urinaria y dolor abdominal: reporte de un caso clínico / Imperforate hymen and hematocolpos as a cause of urinary retention and abdominal pain: A clinical case report

Resumen ANTECEDENTES: El himen imperforado es una malformación congénita del aparato genital femenino, con incidencia de 0.1%. El desarrollo del himen ocurre con la proliferación de los senos bulbo-vaginales y estos se perforan de forma normal antes o después del nacimiento. Al llegar a la adolescencia, la mayoría de los casos suelen manifestar: amenorrea, dolor pélvico, retención urinaria, o los tres. CASO CLÍNICO: Paciente de 12 años, llevada al servicio de Urgencias debido a dolor abdominal intenso y retención urinaria. Primero se estableció el diagnóstico de quiste gigante de ovario; sin embargo, la laparotomía exploradora no evidenció alteraciones ováricas. Mediante estudios de imagen y la exploración física detallada se estableció el diagnóstico de hematocolpos e himen imperforado. Se decidió efectuar la himenoplastia, con lo que se resolvió el cuadro clínico. CONCLUSIONES: El himen imperforado puede causar retención urinaria y dolor abdominal; por tanto, la manifestación de estos síntomas debe considerarse en el diagnóstico diferencial de pacientes adolescentes.

Abstract BACKGROUND: Imperforate hymen is an uncommon congenital malformation of the genital tract, its incidence is 0.1%. Physiologically the development of the hymen occurs for the proliferation of the sinovaginal bulbs, they usually will perforate before or after born. The majority of cases will show clinical manifestations when patient reach puberty, the most common are pelvic pain, amenorrhea and urinary retention. CLINICAL CASE: This is a 12-year-old adolescent patient who went to the emergency department for severe abdominal pain and urinary retention. Initially, the patient was diagnosed with a giant ovarian cyst and a laparotomy was performed without finding ovarian pathology. However, through imaging studies and a more detailed physical examination, the diagnosis of hematocolpos and imperforate hymen was reached. The patient was subsequently subjected to hymenoplasty, which resolved the condition. CONCLUSIONS: The presence of imperforate hymen can cause urinary retention and abdominal pain. It should be suspected in adolescent patients.

Cryptomenorrhoea due to imperforate hymen: a case report

Imperforate hymen is a rare obstructive congenital anomaly of the female genital tract which arises as a result of complete failure of canalisation of the inferior end of the vaginal plate at the junction between the urogenital sinus and the vagina. Its prevalence is 0.05%-0.1%. We are presenting a case of 14 years old girl who came with complaints of lower abdominal pain since 10 days not associated with nausea, vomiting and diarrhoea. She had not attained menarche but her secondary sexual characters were developed with breast, pubic and axillary hair in tanner stage 4. MRI revealed hematocolpos and hematometra with imperforate hymen. Hymenotomy was performed and 300-400 ml of thick tarry colour blood was drained. Her postoperative period was uneventful, and patient was discharged in satisfactory condition. On follow up after 1 month, patient resumed normal menses.

Hematocolpos por himen imperforado en una adolescente / Hematocolpus due to non-perforated hymen in an adolescent

Se describe el caso clínico de una adolescente de 12 años de edad, quien había estado ingresada 5 años atrás en el Servicio de Terapia Intensiva del Hospital Pediátrico Docente Sur Antonio María Béguez César de Santiago de Cuba por presentar enfermedad estafilocócica y amenorrea primaria. Esta vez acudió a consulta con dolor abdominal recurrente desde hacía 3 meses, localizado en hipogastrio, acompañado de náuseas y vómitos, que se aliviaba con los analgésicos habituales. Se le realizó la prueba de embarazo cuyo resultado fue negativo y las imágenes ecográficas sugirieron la presencia de hematocolpos. Se le realizó himenotomía y egresó de la institución 48 horas después con evolución favorable.

The case report of a 12 years-old adolescent is described who had been admitted 5 years ago in the Intensive Therapy Service of Antonio María Béguez Caesar Southern Teaching Pediatric Hospital in Santiago de Cuba staphylococcal disease and primary amenorrhoea. This time she attended the service with recurrent abdominal pain for 3 months, located in hypogastrium, accompanied by nauseas and vomits that were alleviated with the habitual analgesic ones. The pregnancy test was carried out with negative result and the echographic images suggested hematocolpus. The himenotomy was practiced and was discharged from the institution 48 hours later with favorable clinical course.

Imperforate hymen in a pediatric patient. Case report / Himen imperforado en paciente pediátrico. reporte de caso

Los trastornos congénitos del tracto genital femenino se presentan con una incidencia de 1: 10 000-20 000 nacidas vivas, tienen un amplio espectro de manifestaciones clínicas, se describe su detección de manera bimodal, con complicaciones que incluso pueden amenazar con la vida, sin embargo, con un tratamiento oportuno las pacientes pueden tener un buen pronóstico. Se reporta el caso de una paciente de 13 años con cuadro de retención urinaria súbita, estreñimiento agudo, sin menarca y características sexuales adecuadas para la edad, en quien se identificó himen imperforado, hematocolpos. Se descartaron otros posibles diagnósticos diferenciales y el manejo definitivo fue himenotomía más himenoplastía. El himen imperforado hace parte de los trastornos más frecuentes del desarrollo de los genitales femeninos, puede tener múltiples manifestaciones clínicas, leves y severas, con una adecuada identificación, se puede brindar un tratamiento oportuno, y evitar secuelas.

Congenital disorders of female genital tract occurs with an incidence of 1: 10 000 - 20 000 born alive, have a broad spectrum of clinical manifestations, their detection is described bimodally, with complications that may even threaten life, however, with timely treatment patients can have a good prognosis. We report the case of a 13-year-old patient with a sudden urinary retention, acute constipation, no menarche, and age appropriate sexual characteristics, in whom an imperforate hymen, hematocolpos was identified. Other possible differential diagnoses were ruled out and the management was hymenotomy plus hymenoplasty. The imperforate hymen is part of the most frequent developmental disorders of the female genitals, it can have multiple clinical manifestations, mild and severe, however, with an adequate identification, it can be given an opportune treatment, good prognosis and avoiding consequences.

A Case of Imperforate Hymen with Urinary Retention after Puberty

Imperforate hymen is rare, with a low incidence of 1/16,000–30,000 in newborns. Most symptoms occur because of the accumulation of menstrual blood after puberty. In rare cases it can be found before puberty. Periodic abdominal pain, discomfort of the pelvic region, and the like are most commonly observed, and these symptoms increase at bowel movement. Usually a 13- to 15-year-old girl does not experience menarche. Continuous accumulation of menstrual blood leads to vaginal hematoma, or even to hysterovaginal, ovarian, or abdominal hematomas. Rarely, compression of the surrounding tissues can result in upper back pain, dysuria, frequent urination, or oliguria. We report on a rare case of imperforate hymen with urinary retention.

Two cases of hymenal scars occurred by child rape

Children who have been raped some years back may have hymenal scars. However, medical professionals are not accustomed in assessing these scars because of the lack of experience in performing physical examinations of the external genitalia of children who suffered from rape some years back. Moreover, the importance of physical examination of the victim's external genitalia is sometimes overlooked. Two cases of rape victims with hymenal scars who visited Daegu Child Sexual Abuse Response Center several years after their first sexual abuse along with a literature review are presented here.

Congenital Hydrocolpos Mimicking a Mature Cystic Teratoma in the Pelvis

Neonatal hydrocolpos is a rare condition that involves fluid accumulation in the vagina. On diagnostic imaging, the dilated vagina, along with the compressed uterus, can simulate a mature cystic teratoma with a mural nodule. Herein, we report the case of a newborn girl with congenital hydrocolpos that was caused by an imperforate hymen; the hydrocolpos mimicking a mature cystic teratoma on abdominal ultrasonography and magnetic resonance imaging. Any newborn girl with a pelvic cystic mass should be suspected as having a congenital vaginal obstruction manifesting as hydrocolpos or hydrometrocolpos. Thorough examination of the external genitalia, as well as imaging of the uterus and vagina, enables correct diagnosis and optimal treatment.

Dolor abdominal como síntoma de himen imperforado / Abdominal pain as a symptom of imperforate hymen

El himen imperforado es una anomalía congénita del desarrollo genital femenino. A pesar de ser la anomalía obstructiva más frecuente, presenta una incidencia estimada del 0,1% de las recién nacidas. Su diagnóstico es principalmente clínico, habitualmente ante la presencia de dolor abdominal cíclico en una adolescente que no ha presentado la menarquia. Presentamos el caso de una paciente de 12 años de edad que acudió al Servicio de Urgencias por dolor abdominal intenso, acompañado de alteración del hábito intestinal de dos días de evolución. Tras una detallada anamnesis y exploración física, es diagnosticada de himen imperforado con el apoyo de las pruebas complementarias. El cuadro clínico se resolvió tras la realización de una himenectomía.

Imperforate hymen is a congenital anomaly of female genital development. Although it is the most common obstructive anomaly has an estimated incidence of 0.1% of newborn. The diagnosis is primarily clinical, usually in the presence of cyclic abdominal pain in an adolescent who has not submitted menarche. We report the case of a 12 years old woman came to the emergency department by abdominal intense pain accompanied by altered bowel habit in two days. After a detailed history and physical examination, was diagnosed with imperforate hymen with the support of additional tests. The clinical symptoms resolved after performing a hymenectomy.

Imperforate Hymen Causing Hematocolpos and Acute Urinary Retention in a 14-Year-Old Adolescent

We report the case of a 14-year-old girl who visited the emergency room because of suprapubic discomfort and sudden acute urinary retention. She did not have any significant medical and surgical history, and her neurological examinations were all normal. Urinary catheterization led to the passage of 500 mL urine. Abdominal ultrasonography showed a hematocolpos that was compressing the urinary bladder. Gynecologic history taking revealed that the patient has not had menarche yet. Therefore, a cruciate incision was performed and her urination became normal. As the surgical outcome after adequate hymenotomy for imperforate hymen is usually good, the diagnosis of imperforate hymen is important. However, this condition is easily missed in the clinic because the first physician visited by the patient rarely takes a detailed gynecologic history or performs appropriate physical examinations. Although rare, imperforate hymen should be considered as a cause of acute urinary retention in the adolescence period. If an adolescent girl presents with abdominal pain and voiding dysfunction, a detailed gynecologic history and appropriate physical examinations of the genital introitus should be performed.

Lesiones del himen en reconocimientos médico legales (RML) ginecológicos por delitos contra la libertad sexual / Hymen injuries in medical legal recognition (MLR) for crimes against gynecological sexual freedom

Determinar las caracteristícas de las lesiones himeneales y lesiones genitales, paragenitales y extragenitales. Material y Métodos: Se realizó un estudio descriptivo prospectivo de enero a diciembre del 2013. Resultados: Se realizaron 47 RML Ginecólogicos por delitos contra la libertad sexual. El 38,29% (18/47) correspondio a peritadas entre 15 a 17 años. Los hallazgos fueron: himen Integro (18,92%), himen complaciente (8,11%), defloración reciente (8,11%) y defloración antigua (72,97%), entre otros hallazgos. Conclusión: Las desfloraciones antiguas pueden tener lesiones himeneales nuevas, ello debido al diámetro del orificio himenal, existiendo mayor frecuencia cuando el orificio himenal es pequeño y mediano; a diferencia de cuando el orificio himeneal es grande o muy elástico (himen complaciente) que crea dificultades en el reconocimiento de lesiones...

To determine hymenal injuries and genital, paragenital and extragenital lesions. Material and Methods: A prospective descriptive study was conducted January to December 2013. Results: 47 MLR were performed gynecological for crimes against sexual freedom; 38.29 % (18/47) corresponded to women between 15-17 years. The findings were: Integro hymen (18.92 %), willing hymen (8.11 %), Recent deflowering (8.11 %) and old deflowering (72.97 %), among others findings. Conclusion: Older Defloration hymens may have new lesions, this due to the diameter of the hymenal orifice, there most often when the hymenal orifice is small to medium; unlike when the hymen hole is large or very elastic we face a complacent hymen which creates difficulties in recognizing injuries...

Himen imperforado como causa de dolor abdominal en la adolescencia: A propósito de un caso / Imperforate hymen as a cause of abdominal pain in adolescents: a case report

El himen imperforado es una anomalía congénita del desarrollo genital femenino. Es una patología poco frecuente, con una incidencia estimada del 0,1% de los recién nacidos del sexo femenino. En muchas ocasiones, el diagnóstico pasa inadvertido hasta la pubertad y debuta con dolor abdominal cíclico en adolescentes que no han presentado la menarquia. El diagnóstico se basa en la anamnesis y la exploración física, aunque las pruebas complementarias, en especial la ecografía, permiten la comprobación del diagnóstico clínico y la exclusión de otras malformaciones genitales. Se presenta el caso clínico de una paciente de 13 años que fue diagnosticada tras consultar en varias ocasiones por dolor abdominal recurrente.

The imperforate hymen is a congenital anomaly of the female genital development. This is a rare pathology with an estimated incidence of 0.1% in female newborns. In many cases, the diagnosis goes unnoticed until puberty, debuting with cyclical abdominal pain in adolescents who have not submitted menarche. Diagnosis is based on history and physical examination, although additional tests, especially the ultrasound that allows to confrm clinical diagnosis and to exclude other genital malformations. We report a case of a 13-year-old that was diagnosed after consulting several times for recurrent abdominal pain.

Hematocolpos en la infancia. A propósito de un caso / Hematocolpos in Childhood. A case Report

El hematocolpos no es común en nuestro medio, sigue a alteraciones en la génesis del aparato genitourinario femenino; entre las cuales, el himen imperforado es la malformación congénita más frecuente. La sintomatología suele ser variable e inespecífica; el dolor abdominal y los síntomas urinarios es la forma de presentación clínica más usual. La ecografía abdominal-pélvica y la tomografía axial computarizada confirman el diagnóstico y ayudan a descartar otras malformaciones asociadas. Se presentó un caso de una adolescente afectada por esta enfermedad.

The hematocolpos is not common disease. It follow to the alterations in the genesis of female urogenital apparatus among which the imperforate hymen is the most common congenital malformation. The symptoms are variable and nonspecific. The abdominal pain and urinary symptoms is the most common clinical presentation. Abdominal-pelvic ultrasonography and computed tomography help to confirm the diagnosis as well as to find other associated malformations. This article presented a case of an adolescent affected by this disease.

Manejo quirúrgico de un caso de hematocolpos por tabique vaginal transverso

Se presenta un caso de hematocolpos, en una niña de 14 años, sometida a himenotomía en otra institución, sin lograrse evacuar el hematocolpos por presencia de tabique vaginal transverso, siendo transferida a nuestro Hospital. Refería dolor pélvico, disuria, polaquiuria y tumoración en hipogastrio; estaba febril, con presencia de tumoración pélvica hacia fosa iliaca izquierda. La vagina estaba obturada por tabique transversal a 1 cm del introito. Se halló fistula rectovaginal y tumor renitente a tensión de 6 cm hacia pared rectal anterior. Se inició antibioterapia, y la ecografía transperineal localizó el tabique, su grosor y diámetro y distancia del meato urinario. Bajo anestesia epidural y cateterización vesical, se punzó el tabique en el punto medio, obteniéndose 200 mL de material hemopurulento maloliente. Con tracción con sonda Foley triple vía, globo insuflado con 30 mL de suero, se pudo exponer el tabique que fue cortado en rodete con electrobisturí. Se reparó la fístula rectovaginal en tres planos. Por persistencia de fiebre, el piosálpinx fue resuelto al sexto día vía laparoscópica y fue dada de alta al 16º día.

A case of hematocolpos in a 14 year-old girl is presented. She had himenotomy at other institution without evacuation of hematocolpos due to transverse vaginal septum; she was transferred to our Hospital. She complained of pelvic pain, dysuria, polaquiuria and hypogastric tumor; she had fever and a left pelvic tumor. A transversal septum 1 cm from the introitus closed the vagina. Rectovaginal fistula and tense tumor were present at 6 cm towards the anterior rectal wall. Antibiotics were started and transperineal ultrasound localized the septum, its thickness, diameter and distance from the urinary meatus. Under epidural anesthesia and with bladder catheter, the septum was punctured centrally and 200 mL of foul hemopurulent material was obtained. By traction with three-way Foley catheter filled with saline 30 mL the septum was exposed and cut in ring shape with electro scalpel. The rectovaginal fistula was repaired in three layers. Due to persistence of fever pyosalpinx was resolved at the sixth day by laparoscopy and the patient was discharged on day 16.