Pediatric Hematocolpos
Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy in Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Premenarchal females present a diagnostic dilemma due to the presence of the hymen and inability to perform a vaginal exam. Gentle rectal exam may reveal vaginal swelling on one side if mucus has accumulated [42]. Patients can be misdiagnosed as having vaginal infection or even possible sexual abuse or a foreign body in the vagina. Examination under anesthesia is imperative in such cases using a pediatric speculum. This may reveal a single cervix and a vaginal mass on the contralateral side. In postmenarchal females, examination will depend on whether or not the patient is sexually active. If the patient is sexually active, a routine vaginal examination can be performed. If the patient is not sexually active, then examination should be performed under anesthesia. Vaginal examination may reveal one cervix and a mass on the other side of the vagina. The paravaginal mass size depends on the extent of the hematocolpos and how far down the hemivaginal septum reaches distally (Figures 17.4, 17.10, and 17.12). In some patients, it can reach all the way down to the introitus (Figures 17.10, 17.13, and 17.14). These patients will have a large vaginal mass due to a large hematocolpos (Figures 17.10, 17.13, and 17.14) [39]. If the diagnosis is delayed, such patients will also have large hematometra and perhaps hematosalpinx. However, if the hemivagina is high up in the vagina, then there is no vaginal mass that will be seen or palpated by the physician (Figures 17.11 and 17.12). Such patients may have a small hematocolpos and usually a large uterus as a result of hematometra and usually an associated hematosalpinx (Figure 17.12) [39].
Müllerian Anomalies
Juan Luis Alcázar, María Ángela Pascual, Stefano Guerriero in Ultrasound of Pelvic Pain in the Non-Pregnant Female, 2019
Women who have a hemi-uterus with a noncommunicating functional endometrium in a rudimentary horn present a higher incidence of adenomyosis in the rudimentary horn as well as endometriosis in other locations (Figures 7.26 through 7.29). These patients will present pelvic pain, a pelvic mass, hematometra, hematosalpinx by obstruction of menstrual outflow, and infertility. The clinical symptoms usually manifest at menarche. Other patients may be asymptomatic and only diagnosed when complaining due to infertility.14,27,37–40
Perioperative care of the pediatric and adolescent gynecology patient
Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo in Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Patients with obstructive anomalies causing hematometra may develop perioperative fever, but there is no evidence that prolonged antimicrobial treatment after surgical correction is helpful in prevention of postoperative infection. Fever could be associated with inadequate drainage. Regardless, if fever occurs, the patient should be evaluated in the routine manner for postoperative fever and treatment with broad-spectrum antibiotics considered until cultures return. Further research in this area is needed, as there is no literature to guide treatment.
Vulvovaginal graft-versus-host disease: a review
Published in Climacteric, 2019
M. Jacobson, J. Wong, A. Li, W. L. Wolfman
If the patient does not meet diagnostic criteria per the NIH, or if the management would be changed, a vulvar or vaginal biopsy can be undertaken using local anesthesia29. There should be a high index of suspicion for HPV-associated lower genital tract disease and annual Pap or regular HPV testing offered depending on vaginal access30. If the history or physical examination is suggestive of hematometra/hematocolpos, a transvaginal, transrectal, transperineal, or transabdominal ultrasound can be performed. Pelvic magnetic resonance imaging may be another alternative. Hematometra can present as a surgical emergency and the diagnosis should be considered with abdominal mass, urinary retention, cyclic abdominal pain, or lack of bleeding during hormonal withdrawal20,21. Screening for infectious processes or sexually transmitted diseases is not routinely recommended in the absence of clinical suspicion or risk factors, but women taking systemic glucocorticoids or immunosuppressants are at risk for reactivation of viral infections.
The Manchester operation – is it time for it to return to our surgical armamentarium in the twenty-first century?
Published in Journal of Obstetrics and Gynaecology, 2022
Ronen S. Gold, Hadar Amir, Yoav Baruch, David Gordon, Mordechai Shimonov, Asnat Groutz
There were four cases of late postoperative complications that required surgical intervention: vesicovaginal fistula, hematometra, pyometra and transvaginal small bowel evisceration. All four patients underwent uneventful Manchester operation. Three of the four patients underwent concomitant anterior and posterior colporrhaphy, two of whom also underwent TVT-O. The first patient (age 67 years, BMI 29.5) had vesicovaginal fistula that was diagnosed two months postoperatively. The second patient (age 45 years, BMI 22.6) underwent drainage of hematometra three months postoperatively with complete recovery thereafter. The third patient (age 67 years, BMI 24.2) presented with abdominal pain and fever 6 months after surgery. The presumed diagnosis following physical examination, pelvic sonography and lab tests was pyometra. The patient underwent total abdominal hysterectomy after a failed hysteroscopic attempt to drain the pyometra. The forth patient (age 57 years, BMI 19) presented 9 days after surgery with small bowel evisceration through the posterior vaginal fornix. Her past medical history has been unremarkable, with the exception of underweight and a trans urethral removal of bladder tumour (TURBT) for early stage bladder cancer 5 years earlier. The patient underwent emergency laparotomy in which the intestine was inspected and the posterior vaginal fornix was sutured. Her postoperative follow up was unremarkable.
A non-gravid incarcerated uterus following a suction dilation and curettage: a case report
Published in Journal of Obstetrics and Gynaecology, 2022
Marie-Claire Leaf, Melissa Perez, Katherine Coakley
This case represents a rare complication of suction dilation and curettage in a patient with a retroflexed uterus. A detailed and thorough literature review revealed no published reports of uterine incarceration following a D and C. Although pathophysiology of non-gravid uterine incarceration is unclear, uterine anomalies including leiomyoma appear to be major contributors to the condition. In this case, the anterior submucosal fibroid previously seen on ultrasound likely obstructed the outflow of blood from the uterus, causing hematometra. Hematometra then lead to an enlarged uterus and eventually to its incarceration as evidence by the engorged uterus on laparoscopy.
Related Knowledge Centers
- Amenorrhea
- Dysmenorrhea
- Hypotension
- Imperforate Hymen
- Menstruation
- Urinary Retention
- Vaginal Septum
- Uterus
- Frequent Urination
- Reflex Syncope