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Vaginal Swellings
Published in Tony Hollingworth, Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
The hymen is a membrane that partially covers the external vaginal opening in girls. When the membranous fold completely blocks the external vaginal orifice, it is called imperforate hymen.3 As a result of this occlusion, the secretions or the blood accumulate in the vagina instead of escaping out during menstrual periods. Often it is not diagnosed until puberty, as children are asymptomatic with this condition. They then typically present with cyclical lower abdominal pain and amenorrhoea (absence of periods) with or without urinary retention. Examination of the genitalia reveals a bluish bulging membrane (see Fig. 3 in Menstrual periods, absent) at the external vaginal orifice owing to collection of blood behind the membrane (haematocolpos). The treatment involves minor surgery (cruciate incision on the hymen or hymenotomy) to create an opening to facilitate the flow of menstrual blood externally.
Pediatric Hematocolpos
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Omar M. Abuzeid, Mostafa I. Abuzeid
Once the diagnosis is made, the treatment is to perform hymenotomy by making an incision in the imperforate hymen and to drain the retained chocolate-colored fluid. Various surgical techniques have been described; perhaps the most common technique is a cruciate incision through the hymenal membrane, followed by excision of the triangular parts of the membrane (Figure 17.7A and B) [20]. This is followed by approximation of vaginal mucosa and skin at the introitus using 4-0 Vicryl sutures in an interrupted manner. The hymen, however, is accepted as a sign of virginity. Therefore, in some cultures, a subsequent hymenorrhaphy may be necessary. Alternatively, a hymen-sparing surgery has been suggested by Basaran et al. [21] and Ali et al. [22]. In a small series of three patients, Basaran et al. [21] made a vertical incision in the midline of the higher portion of the hymen. This allows preservation of a wider posterior hymenal tissue [21]. Drainage of the chocolate material was done using a small suction device, and then the borders of the hymen were sutured obliquely using a few interrupted 5-0 Vicryl sutures to form a more or less circular opening. The authors reported that normal anatomy was restored with a normal-appearing hymenal ring after 4 weeks of treatment [21]. They concluded that a simple incision and sutures will eventually form a thick posterior rim of hymenal tissue that is adequate for defloration during sexual intercourse [21]. Another hymen-sparing surgery was described by Ali et al. [22]. In brief, a 0.5-cm diameter small circular hole was made in the middle of maximum distention of the imperforate hymeneal membrane to allow passage of a Foley catheter (14–16 French) in the vagina [22]. An oval-centralize closure on the imperforate hymen membranes was then performed [22]. The old blood within the vagina was drained by applying pressure to the vagina by a finger placed in the rectum. Normal saline was used to wash the vagina, and then the Foley catheter was introduced in the vagina and its balloon was inflated with 10 mL of water [22]. The catheter was taped to the inner side of the thigh and was connected to a small bag. The Foley catheter was left in place for 2 weeks [22]. A single dose of prophylactic antibiotic was administered. Topical estrogen cream was applied to the introitus to prevent adhesion formation and to help the healing process [22]. A single dose of prophylactic ceftriaxone was administered [22]. In their reported series of 13 patients, a circular hymen was formed, and defloration was seen in all the patients [22].
OHVIRA syndrome presenting with acute abdomen findings treated with minimally invasive method: three case reports
Published in Acta Chirurgica Belgica, 2022
Reyhan Gündüz, Elif Ağaçayak, Mehmet Sıddık Evsen
Our first and second patients were 14 and 15 years old, respectively, they presented at the Obstetrics and Gynaecology Department of Dicle University Medical Faculty with acute abdomen findings in 2013. Both patients had begun to menstruate approximately a year prior to presentation with menstrual periods every 25–30 days lasting 4–5 days in the form of spotting. They reported that they had been experiencing sensation of vaginal swelling and pressure during menstruation which progressively increased in intensity with each cycle. Both patients were admitted to the emergency department with severe abdominal pain approximately a year after menarche. Pelvic ultrasonographic (US) examinations performed in the emergency department revealed normal ovaries and an appearance in the uterine cavity consistent with haematometra, which prompted magnetic resonance imaging (MRI) for suspected uterine anomaly. Pelvic MRI revealed the appearance of uterus didelphys, haematocolpos, and haematometra were observed in the left endometrial cavity and left vagina. In addition, an appearance consistent with haematosalpinx was observed in the left pelvis (Figure 1). Physical examination revealed normal secondary sexual characteristics and normal external genitalia. Urogenital anomalies were considered, and the patients were evaluated for renal pathologies. Both patients had left renal agenesis with compensatory hypertrophy of the right kidneys. No additional urological pathology was found. C-reactive protein, white blood cells, and biochemistry values of the patients were normal. After obtaining consent from the patients and their families, hymenotomy and left transverse vaginal septal resection were performed under general anaesthesia during their menstrual periods. A 0.5- to 1-cm septal incision was made, approximately 400–450 mL coagulum was drained from the uterus and vagina, the incision was marsupialized, a balloon catheter was placed in the uterus, and the balloon was inflated to approximately 20 mL. Hymen repair was performed after the procedure. After the pain has subsided, the uterine catheter was removed at 24 h postoperative and the patients were discharged on the postoperative day 2. Both patients underwent a controlled examination approximately two weeks later. US examination revealed that both uterine cavities and endometrial thickness were normal. Postoperative histories of the patients revealed that their cycle lengths were 25–30 days, the periods lasted 4–5 days and the bleeding was not in the form of spotting. Our second patient is married and has a living child. Her pregnancy ended with caesarean section at term.