Noia d'11 anys amb dolor abdominal cíclic de llarga evolució / No disponible

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Missed diagnosis of imperforate hymen later presenting with hypertension.

An adolescent girl presented with hypertension and was found to have haematocolpos and imperforate hymen. She had a background of chronic abdominal pain and had sought medical attention multiple times prior, with the diagnosis being missed as pubertal evaluation and perineal examination had been neglected during those visits. Hypertension resolved following hymenectomy and drainage of haematocolpos with no long-term sequelae.

Lumbalgia en adolescente de 12 años como manifestación clínica de hematocolpos por himen imperforado / Low back pain in 12-years old adolescent as clinical manifestation of hematocolpos secondary to imperforate hymen

Presentamos un caso de hematocolpos debido a himen imperforado, diagnosticado en paciente de 12 años que es remitida al Servicio de Urgencias por lumbalgia mecánica de 2 semanas de duración sin mejoría a pesar de tratamiento con antiinflamatorios no esteroideos y relajantes musculares. La paciente presentaba dolor lumbar intenso que interfería en el descanso nocturno, sin antecedente traumático previo, y asociaba las últimas 24 horas dificultad para realizar micción. Una anamnesis y exploración física detallada son suficientes para diagnosticar una patología que, aunque poco frecuente, tiene un tratamiento quirúrgico sencillo y cuyo diagnóstico puede evitar multitud de exámenes complementarios y tratamientos farmacológicos innecesarios (AU)

We present a case of hematocolpos due to an imperforate himen, diagnosed in a 12 years old patient who was referred to the Emergency Service because of a two weeks duration mechanic lumbago which did not improve despite the treatment with NSAIDs and muscle relaxants. The patient had severe low back pain that interfered with the night rest, with no previous history of trauma, and in the last 24 hours, also presented difficulty in urination. The study of the medical records and a physical exploration were enough to diagnose a pathology that, although rare, has a simple surgical treatment and whose diagnosis can prevent many complementary exams and unneccssary drug treatments (AU)

Síndrome OHVIRA (hemivagina obstruida y anomalía renal ipsilateral) asociado a útero didelfo / Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) associated to uterus didelphys

La asociación de útero didelfo, hemivagina obstruida y aplasia renal ipsilateral es una entidad rara, diagnosticada habitualmente después de la menarquia, que cursa con dismenorrea y dolor pélvico cíclico secundario a hematocolpos. Aunque la ecografía es de elección para la valoración inicial, la resonancia magnética es la técnica que permite clasificar la anomalía. El reconocimiento temprano facilita la exéresis quirúrgica del septo vaginal obstructivo, con alivio rápido de los síntomas y prevención de complicaciones. Dado que la agenesia renal o la displasia multiquística son un diagnóstico prenatal o neonatal frecuentes, sería recomendable buscar una anomalía mulleriana asociada en estos casos (AU)

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis is a rare entity that usually presents after menarche with dysmenorrhea and cyclic pelvic pain due to hemihematocolpos. Although ultrasound scanning allows correct diagnosis, magnetic resonance imaging plays a decisive role in characterizing the malformation. Early diagnosis is important so that prompt excision of the vaginal septum can relive pain and prevent further complications. The possibility of an obstructed Müllerian system should be investigated whenever a multicystic dysplastic kidney or the absence of a kidney is diagnosed in a fetus or neonate (AU)

Vaginal stenosis following allogeneic bone marrow transplantation for acute myeloid leukaemia.

We report the unusual complication of vaginal stenosis occurring after allogeneic bone marrow transplantation (BMT) for leukaemia. This was in all likelihood a manifestation of chronic graft-versus-host disease (cGVHD), although the patient has no other stigmata of this and suffered little acute graft-versus-host disease (aGVHD) after BMT. Other risk factors for vaginal stenosis were considered and appear to be absent in this patient, although the total body irradiation used as part of her conditioning therapy may play a role. We suggest that vaginal stenosis may be under-reported, since female patients suffer a number of gynaecological complications after BMT, and that regular questioning and examination may aid in making an earlier diagnosis, allowing speedier instigation of therapy and thus improving quality of life.

Robinow syndrome, vaginal atresia, hematocolpos, and extra middle finger.

A 14-year-old girl with Robinow syndrome was admitted with severe abdominal pain that had recurred periodically during the last 6 months. She had been followed by us since age 2 months and she had not experienced menarche yet; hematocolpos related to vaginal atresia was diagnosed. She underwent vaginoplasty with cervical construction. Genital system abnormalities are common in Robinow syndrome, but this kind of malformation has not been reported previously.

Hematometrocolpos / Hematometrocolpos

Apresentam-se dois casos de hematometrocolpos: uma adolescente com massa abdominal e amenorréia primária e uma senhora tratada de uma neoplasia de cérvix por radioterapia e que retornou cerca de 1 ano depois apresentando dor abdominal intensa. Ambos os casos evoluiram satisfatoriamente, apesar de levarem a alguma dificuldade diagnóstica. Chama-se a atençäo para o quadro clínico das pacientes onde prevaleceu a amenorréia, cólicas intermitentes e massa no hipogástrico. O uso da ultra-sonografia é avaliado como arma propedêutica

Imperforate hymen with hematocolpos.

Presented are two cases of imperforate hymen with hematocolpos seen in a pediatric emergency department (ED) during a seven-month period. The first case presented with abdominal pain, urinary obstruction, and constipation on initial visit. The diagnosis was not made on the initial presentation. The patient was seen a second time, and final diagnosis was not made until a third visit to the pediatric outpatient clinic. The second case presented with syncope and bilateral lower abdominal pain. Ultrasound and subsequent surgery confirmed the physical findings in the ED of imperforate hymen and hematocolpos. Both patients underwent hymenectomy, and they have experienced no further symptoms.