hematocolpos

Caption: Fig 2a: Hematocolpos with agenesis of the lower vagina.

The main symptom detected among the patients was dysmenorrhea and pelvic pain due to the presence of an obstructed hemivagina that resulted in the accumulation of metabolized blood, causing hematocolpos, hematometra, and hematosalpinx.

However, the right vagina was obstructed inferiorly and was hugely distended with blood consistent with hematocolpos. It measured 12 x 7 x 7 cm.

All physicians should be aware of this entity in differential diagnosis of hematocolpos, abdominal pain and primary amenorrhea in early adolescent years.

We there proposed a subdivision for the mesonephric anomalies presenting with: (a) Large hematocolpos in a blind hemivagina (Wunderlich syndrome); (b) Gartner's pseudocyst in the anterolateral wall of the permeable vagina (frequently as a Herlyn–Werner syndrome); (c) partial reabsorption of the intervaginal septum; and (d) complete unilateral vaginal or cervico-vaginal agenesis with or without communication between both hemiuteri.

If diagnosis is delayed, the mucus usually resorbs and the child remains asymptomatic until menarche, when she presents with a bulging hymen and a large hematocolpos, as in the opening case.

Cases of damage to the vaginal walls leading to total occlusion of the vaginal introitus and hence hematocolpos have also been reported.

Long-term consequences of genital involvement are labial agglutination, introital stenosis, vaginal synechiae and stenosis, vaginal and vulval adenosis, hematocolpos, and hematometra.

A transverse incision of 1.5 cm was taken over the left bulge and approximately 200 ml chocolate colored fluid was drained suggestive of hematocolpos. A normal cervix was visualized inside.

Hematocolpos may occur only a few months after menarche.

The differential diagnosis for primary amenorrhea with a present uterus includes an imperforate hymen, which can also cause hematocolpos. Imperforate hymen is not a mullerian anomaly, and distinction from a transverse vaginal septum can be difficult--although the treatment is similar.

Clinical signs included vaginal fullness, ruptured hematocolpos, pyometra, and pelvic masses.

The patient was diagnosed with HWW syndrome with a history of hematocolpos and vaginoplasty at the age of 12, and had undergone cesarean section at the age of 16.

[7] As an obstructing vaginal malformation, this condition precludes the outflow of menstruation, resulting in hematocolpos, hematometra, and hematosalpinx.