Abstract

Introduction : Imperforate hymen occurs in approximately 1 in 1, 000 females. It can be found incidentally on physical examination, it is treatable and does not cause significant morbidity. If it is not screened for and treated early, patients present at menarche with a history of cyclical pelvic or abdominal pain and symptoms of urinary retention due to hematocolpos. Case presentation : A 12-year-old premenarchal girl presented to the emergency department with cyclical hypogastric abdominal pain and pollakiuria, with 6 months-evolution. Her medical history was unremarkable, she had never been menstruated or sexually active. She took no medications. Examination of the perineum revealed an imperforate hymen protruding from the introitus. A Y incision was made on the imperforate hymen and during hymenectomy 500mL of brown blood (viscous chocolate colored) was drained from the vagina. She was discharged on postoperative day 2. At the follow-up visit (52nd postoperative day), the patient reported her symptoms had resolved. Conclusion : Although rare, imperforate hymen with retrograde menstruation can cause dilatation of the vagina and uterus (i.e., hematocolpometra). It is an important differential diagnosis of abdominal pain in premenarchal girls often associated with urinary symptoms. It is easily diagnosed by physical examination. © 2014 Associação Portuguesa de Urologia. Published by Elsevier España, S.L.U. All rights reserved.