Hematometra y hematocervix en paciente postmenopáusica: reporte de caso / Hematometry and hematocervix in postmenopausal patient: case repor

El hematometra es la retención de sangre en el útero y comúnmente se presenta en mujeres jóvenes con anomalías mullerianas pero puede aparecer también en mujeres postmenopausicas por causas secundarias como traumas, tumores, terapia de remplazo hormonal, estenosis cervical, entre otras. En esta presentación de caso interesante se describe una mujer postmenopáusica bajo terapia de remplazo hormonal. Dicha mujer inicia con hemorragia uterina anormal por lo que se le realiza ultrasonido evidenciando hematómetra y hematocervix. Como método diagnóstico y terapéutico de la hemorragia postmenopáusica se le realiza histerectomía abdominal en la cual la patología evidencia leiomiomatosis uterina con endometrio secretor

Hematometra is the retention of blood in the uterus and commonly occurs in young women with Mullerian abnormalities but can also appear in postmenopausal women due to secondary causes such as trauma, tumors, hormone replacement therapy, cervical stenosis, among others. In this presentation an interesting case is described a postmenopausal woman under hormone replacement therapy. She said woman began with abnormal uterine bleeding, so an ultrasound was performed showing hematometer and hematocervix. As a method diagnosis and treatment of postmenopausal hemorrhage, abdominal hysterectomy is performed in which the pathology shows uterine leiomyomatosis with secretory endometrium

A second glance on Cervicovaginal Agenesis

@#Mullerian anomalies arise from the failure in the development of Mullerian ducts and their associated structures during organogenesis which confers adverse impact in fertility and reproductive health. Presented is a rare case of a 15 year old nulligravid, who presented with a chief complaint of severe cyclic hypogastric pain associated with primary amenorrhea. Complete clinical history, physical examination and sonographic findings pointed to a diagnosis of cervical hypoplasia associated with functioning uterine corpus and an absent vagina. Patient underwent total abdominal hysterectomy with left salpingectomy and bilateral oophorocystectomy, for hematometra, bilateral endometriotic cysts, and hematosalpinx. This case report discusses the management of cervicovaginal agenesis through a multidisciplinary approach by a team composed of an obstetrician-gynecologist, reproductive endocrinologist, pediatrician, and pediatric surgeon for proper evaluation, diagnosis, and management of this case.

Síndrome de Hemivagina Obstruida, Útero Didelfo y Agenesia Renal Ipsilateral (OVHIRA), Drenado Parcialmente por Fístula Útero-Uterina Espontánea / Obstructed Hemivagina Syndrome, Uterus didelphys and Ipsilateral Renal Agenesis (OVHIRA), Partially Drained by Spontaneous Uterine-Uterine Fistula

RESUMEN Antecedentes: El síndrome de hemivagina obstruida, útero didlefo y anomalía renal ipsilateral (OVHIRA) es una malformación mülleriana infrecuente. Objetivo: Se presenta un caso con una complicación no antes descrita y se hace una revisión de la literatura hasta la fecha. Caso clínico: Mujer de 12 años de edad con antecedentes de diagnóstico de útero bicorne y agenesia renal derecha en la infancia. Veintidós meses post menarquia consulta por algia pelviana y dismenorrea premenstrual. Ecografía revela hematómetra en cuerpo uterino izquierdo, de 142 x 69 x 61 mm. Resonancia nuclear magnética (RNM) describe además un hematocolpos de 7 x 10 cm y un tabique vaginal transverso de hemivagina izquierda. Se diagnostica OHVIRA y se planifica cirugía para resecar el tabique. Días antes del la cirugía, la paciente tiene episodio de metrorragia. Ecográficamente se constata una disminución considerable del volumen de hematómetra. En la cirugía se pesquisa fístula uterina que comunica útero obstruido izquierdo con útero no obstruido derecho por donde había drenado espontáneamente la hematómetra. Al resecar el tabique vaginal izquierdo se termina de drenar hematómetra y hematocolpos. Al alta, paciente se maneja con dilatación vaginal progresiva por seis meses para evitar la estenosis del tabique. Conclusión: Se presenta una complicación no descrita, fístula útero uterina, de una malformación mülleriana infrecuente (OVHIRA). El proceso diagnóstico meticuloso, la cirugía bien planificada y la dilatación vaginal prolongada permitieron tener éxito en su manejo.

ABSTRACT Background: Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome (OHVIRA) is an uncommon Müllerian anomaly. Objective: A case is described and the main complications related to the syndrome are reviewed. Case report: Female, 12 years old, with a medical history of a bicornuate uterus and right renal agenesis diagnosed at birth. Twenty-two months post menarche she seeks medical attention due to pelvic pain, menometrorrhagia and premenstrual dysmenorrhea. An ultrasound revealed a hematometra, of 142 x 69 x 61 mm, in the left uterus. Magnetic resonance imaging also described a 7 x 10 cm hematocolpos and a transverse vaginal septum of the left hemivagina. OHVIRA is diagnosed and surgery is planned to resect the septum. Two days before the surgery, the patient has an episode of abundant metrorrhagia. Ultrasonographically a considerable decrease in the volume of the hematometra is observed. In surgery, a uterine fistula is discovered which communicates the left obstructed uterus with the right unobstructed uterus, where the hematometra had been partially drained. During the procedure, the left vaginal septum is resected, which completes the drainage of the hematometra and hematocolpos. At discharge, the patient undergoes progressive vaginal dilation for six months to avoid stenosis of the septum. Conclusion: An utero-uterine fistula has not been previously described as a complication of OHVIRA. The meticulous diagnostic process, the well planned surgery and the prolonged vaginal dilation allowed for a successful management.

Vaginal agenesis: A case report / Philippine Journal of Obstetrics and Gynecology

Congenital anomalities of the vagina are rare congenital anomalies. Women born with this anomaly present with collection of blood in the uterine cavity or hematometra and pelvic pain. Presented is a case of a 12-year old girl with hypogastric pain and primary amenorrhea complicated by vaginal agenesis. She was managed conservatively by creating a neovagina with the use of bipudental flap or Modified Singapore flap. Management can be non-surgical or surgical but the management of congenital vaginal agenesis remains controversial. The decision to do a conservative surgical procedure or a hysterectomy depends on the clinical profile of the patient, the expertise of the surgeons, the extent of the anomaly, and it's association to other congenital anomalies.

Cervicovaginal agenesis: A case report / Philippine Journal of Obstetrics and Gynecology

Congenital absence of the uterine cervix and vagina in the presence of a functional endometrium is an extremely rare congenital anomaly. Women born with this anomaly present with collection of blood in the uterine cavity or hematometra, disabling pelvic pain and progressively worsening endometriosis. Presented is a case of a 16 year-old girl with severe pelvic endometriosis and hematometra complicated by cervicovaginal agenesis. She was managed by total abdominal hysterectomy with bilateral salpingectomy, left oophorocystectomyandadhesiolysis. Surgical management of congenital cervicovaginal agenesis remains controversial. The decision to do a conservative surgical procedure or a hysterectomy depends on the clinical profile of the patient, the expertise of the surgeon, the extent of the malformation and its association with other mullerian anomalies.

Cervical agenesis: a case report

A 24 year-old patient, single, with cervical agenesis and imperforate hymen is presented. She underwent hymenectomy for hematosalpinx and right oophorectomy for endometriosis, before finally undergoing hysterectomy. Cervical agenesis is a rare anatomic developmental abnormality and proposed guidelines in managing similar conditions are reviewed in this report. The management of choice will defend on the condition of the patient and the availability of resources. The patient underwent multiple surgeries in the past. However, despite all efforts to address her medical condition, due to the complications, the small chance of getting pregnant, and the absence of an experienced surgeon capable of performing a reconstructive procedure, she was eventually convinced to undergo hysterectomy. With cervical agenesis, the patient is faced with psychological difficulties that should be addressed. One can only hope that the future will hold a more optimistic outlook for young girls with this rare congenital abnormality.

Spontaneous uterine rupture secondary to recurrent haematometra from cervical stenosis

Cervical stenosis is a challenging condition that often recurs despite intervention. Multiple therapeutic options have been described, but a clearly effective and reliable treatment method has yet to be identified. Patients with recurrent stenosis are at risk of developing severe complications such as chronic pelvic pain and infertility. We describe a case of congenital cervical stenosis with secondary haematometra in which repeated cervical dilatation, hysteroscopic canalisation and administration of medications to retard endometrial development were unsuccessful in relieving the obstruction and preventing re-accumulation of menstrual blood. Total hysterectomy was eventually mandated by spontaneous rupture of the haematometra.

A life threatening complication of an imperforate hymen : a case report

A not so benign disease of imperforate hymen in a 20 year old who presented with acute hypogastric pain will be discussed. The diagnosis of an imperforate hymen should be made during routine neonatal pediatric examination. However, it is not unusual to see a teenage girl present with typical findings of cyclic adominal pain, urinary retention, constipation and a bulging introital mass with hematocolpos and hematometra on ultrasounds examination. Additional findings may include hematosalpinges and formation of endometrial cysts with severe pelvic adgesions. Conservative management generally includes hymenectomy with drainage of the blood and antibiotic therapy. Patients are generally discharged after 24 hours or the procedure is done as an outpatient basis with oral pain medications given. However in our case, the dilemma in terms of management of conservative versus aggressive surgery was encountered. Our patient was only 20 years old presenting with primary amenorrhea and cyclic dysmenorrhea for 7 years with the possibility of a pelvic "clean up" and the problems of premature menopause and infertility were at the back of our minds. A greater awareness of this complication should prompt clinicians to consider this entity when dealing with cases such as this one.

The pitfalls in the diagnosis and management of distal vaginal agenesis: a report of three cases

Vaginal agenesis is an uncommon congenital anomaly and such complex malformations are usually incorrectly identified. Deviations from the normal embryologic events in the reproductive system may result to malformations which may exhibit with the same clinical presentation. A complete history and physical examination coupled with appropriate imaging techniques are necessary to arrive at a correct diagnosis. Physicians must be aware of the differential diagnosis and management options available. A correct diagnosis must be made prior to any surgical intervention to prevent inappropriate surgeries with their anticipated complications. In cases with vaginal outlet obstruction, an accurate diagnosis with the adequate treatment reduces the need for re-operations and subsequent complications. Reported are three misdiagnosed cases of distal vaginal agenesis resulting to unwarranted surgical interventions.

A clinical epidemiological study of the quantitative diagnosis scale of blood stasis syndrome / 中国结合医学杂志

<p><b>OBJECTIVE</b>To establish the diagnosis scale of blood stasis syndrome (BSS) and explore the idea and method of using scale to research the quantitative diagnosis of Chinese medicine (CM) syndrome.</p><p><b>METHODS</b>Combining the modern epidemiology, consulting the access of quality of life scale, and colligating multi-angle methods to make the scale.</p><p><b>RESULTS</b>The scale had relatively good reliability and validity and could be used to estimate the degree of stasis and analyse the curative effect.</p><p><b>CONCLUSIONS</b>It was a reference for CM syndrome diagnosis that combines screening methods of scale entry with quantitative diagnosis to establish the quantitative diagnosis scale.</p>

Himen imperforado con hematocolpus y hematometra secundario: presentación de un caso / Imperforate hymen with Hematocolpus and Secondary Ematometra: presentation of a case

El himen imperforado es una patología poco frecuente del tracto genital femenino. Presentamos un caso de himen imperforado, en una paciente virgen de 17 años de edad con amenorrea, dolores en bajo vientre de forma cíclica con intervalos de más o menos 15 días y un aumento de volumen en hipogastrio, la que fue atendida durante nuestra misión médica realizada en el hermano país de Venezuela. Se realizó ecografía abdominopélvica con la vejiga llena y se observaron imágenes sugestivas de colpohematometra. La paciente fue intervenida quirúrgicamente, se le realizó incisión y resección de la porción central de la membrana himeneal, con evacuación del contenido sanguinolento, confirmándose el diagnóstico. No se presentaron otras complicaciones y la paciente fue dada de alta con evolución satisfactoria. Se revisó y actualizó la literatura al respecto.

The imperforate hymen is not a very frequent pathology of the feminine genital tract. A case of imperforate hymen was presented, in a 17 year-old virgin patient with amenorrhea, having pains in low stomach in a recurrent way with intervals of more or less 15 days and an increase of volume in hypogastrium, the one that was assisted during our medical mission carried out in Venezuela, our brother country. An echography was carried out abdominopelvic with the full bladder and suggestive images of colpohematometra were observed. The patient was intervened surgically. An incision and resection of the central portion of the membrane hymeneal was carried out to the patient with evacuation of the bloody content being confirmed the diagnosis. There were not any other complications and the patient was discharged from the hospital with satisfactory evolution. It was revised and it modernized the literature in this respect.

Hematocervix y sinequia cervical: caso clínico / Hematocervix and cervical adhesion: clinical case

We report a case of hematocervix diagnosed by ultrasonography in a perimenopausal patient with no history of cervical pathology. We discuss the etiology of this alteration, usefulness of ultrasound diagnosis, its surgical treatment and its relationship with pathologies affecting some other organs and systems.

Se presenta un caso clínico de hematocervix diagnosticado por ultrasonografía en una paciente perimenopáusica sin antecedentes de patología cervical. Se discuten las causas de esta alteración, la utilidad del diagnóstico por ultrasonido, su tratamiento quirúrgico y su relación con patologías en otros órganos y sistemas.

Simultaneous occurrence of hematometrocolpos and consecutive pregnancies in uterine didelphys : a case report.

Hematometrocolpos drained abdominally at laparotomy done, with suspicion of an ovarian torsion in an adolescent with ipsilateral renal agenesis, was eventually rediscovered to have in coexistent uterine didelphys in a 25 year P3+0 at the time repeat caesrean for breech in the event of third parturition, complicated by partum hemorrhage as in all her previous delivery (first vaginal delivery and retained placenta, second caesarean for obstructed labor by non pregnant half of didelphic uterus). This illustrates how simultaneous occurrence of hematometrocolpos can go unnoticed although there was every reason for this condition not to go unrecognized for the simple fact ofhemivaginal obstruction and hematometra with ipsilateral renal agenesis (on the left side) unaffecting the consecutive pregnancy in the other uterus.

Occlusion of upper genital tract following lower segment caesarean section for placenta praevia

Uterine cavity occlusion following caesarean section for central placenta praevia culminating in haematometra and thereby amenorrhoea is one of the rarest long term complications of lower segment caesarean section. We report a case of 28 year old primigravida with Grade 4 placenta praevia who underwent elective caesarean section at 35 weeks gestation. She presented at Nizwa Hospital, Sultanate of Oman, after 7 months with cyclical lower abdominal pain and amenorrhoea. She was treated by hysteroscopic adhesiolysis and an in utero Foley's catheter. She had complete resolution of her condition within 2 months and resumption of menstrual cycles. Multiple haemostatic sutures at caesarean section for placenta praevia can be an causative factor for such a complication along with other risk factors like multiple caesarean sections, chorioamniotis etc. Recognition of these factors, meticulous surgical technique and appropriate post operative care can effectively prevent it

A case of transverse vaginal septum with modified Garcia technique / 대한산부인과학회지

The incidence of all transverse vaginal septum is 1:2,100 - 1:72,000. The transverse vaginal septum is a developmental defect of vagina which may be fused incompletely between the Mullerian duct component and the urogenital sinus component of vagina. Serious complications may be hematocolpos, hematometra and hematosalpinx. Simple surgical excision or simple incision have been developed to treat congenital transverse vaginal septa, but also caused common complications such as secondary tissue contracture. Garcia technique using eight vaginal mucosa flaps was developed to avoid common complication of secondary vaginal stenosis. Here, we present a case of contracted transverse vaginal septum who has been performed a simple incision 13 years ago, successfully performed the modified Garcia technique without serious postoperative complication.

Laparoscopic management of uterine anomaly associated with agenesis of unilateral kidney and pelvic endometriosis: two case reports / 대한산부인과학회지

Unicornuate uterus with a rudimentary horn hematometra and bicornuate uterus with unilateral hematometra is rare congenital anatomic anomalys of the female genital system. these patients present with dysmenorrhea, dyspareunia, pelvic mass, urinary tract anomalies and pelvic endometriosis. We have experienced a case of rudimentary uterine horn hematometra with agenesis of ipsilateral kidney and pelvic endometriosis in a 18 years old girl and a case of bicornuate uterus with unilateral hematometra associated with agenesis of ipsilateral kidney and pelvic endometriosis in a 14 years old girl. and we treated by laparoscopic management. So we report two cases with a brief review of literatures.

Case Report: A new surgical technique for Transverse Vaginal Septum / 대한산부인과학회지

Transverse vaginal septum, especially completely imperforate condition, is a rare congenital anomaly of female genital tract. The patient was 26 years old and visited for primary amenorrhea and low abdominal pain. Secondary sexual characteristics were all normal, but the depth of the vagina was only about 1cm. Hematometra was suspected and two large cystic structures were detected in the pelvis on ultrasonography. Intravenous pyelography and other laboratory results were normal. Vaginoplasty was needed to drain out the hematometra. We tried a new surgical technique using radial incisions of the closed vaginal end. To prevent postoperative contracture, we used a sterile pen case. and educated the patient to dilatate the vagina with that, daily. Here, we report a case of complete imperforate transverse septum with reviews of literatures.

Two Cases of Imperforate Hymen with Hematocolpometra / 대한산부인과학회잡지

Imperforate hymen is a rare congenital malformation. Two cases of imperforate hymen regarded to congenital origin, and formed hematocolpometra. In most instances definite finding is noticed after menarche as retention of menstrual flow results in abdominal pain, distension of the lower abdomen and often in acute urinary retention. Two cases of imperforate hymen associated with hematocolpora, hematometra and abdominal distension at age of 14 and 16 were treated satisfactorily by simple crucial incision of hymen, and drained of about 800 cc and 600 cc of tarry blood respectively. We present two cases of imperforate hymen with review of the literatures.

Hematocervix en paciente posmenopáusica con antecedente de electrocoagulación: caso clínico / Hematocervix in postmenopausal patient with history of electrocoagulation: case report

La colección hemática intrauterina, llamada hematometrio, no es de muy rara aparición. Sin embargo, el hematocervix es una verdadera curiosidad, con menos de diez casos reportados en la bibliografía disponible. En esta nota clínica se presenta un caso de hematocervix en una mujer posmenopáusica que usaba irregularmente terapia de sustitución hormonal, a quien previamente se le practicó electrocoagulación del cuello uterino

Hematometra por Listeria monocytogenes / Hematometra & listeria monocytogenes

El hematometra es una entidad nosológica que no siempre debe atribuirse a un defecto embrionario del paramesonefros. Se mencionan también como posibilidades etiológicas a las infecciones cervicovaginales por Listeria monocytogenes (Lm), neoplasias malignas del cérvix, iatrogenias por ablación endometrial con láser, por legrado uterino cruento y por criocoagulación o electrocoagulación cervical. El caso a referir es el de una mujer en edad reproductiva de 32 años, que presentó la menarca los 13 años, iniciando su vida sexual a los 31 años y no empleó ningún método en el control de su fertilidad. Al presentar amenorrea de ocho semanas después de ocho meses de casada asiste a consulta por supuesto embarazo; dentro de los estudios prenatales se solicita estudio ecográfico pélvico, encontrando imágenes compatibles con hematometra, el cual fue drenado, demostrando la presencia de Listeria monocytogenes (Lm) por anticuerpos anti-Lm. Fue tratada con azitromicina y espiramicina.