Acute Urinary Retention due to Haematometrocolpos from Imperforate Hymen in a Pubescent Nigerian Girl.

Background: Cryptomenorrhoea is an uncommon gynaecological condition in the adolescent age group. While cyclical abdominal pain is the usual clinical symptom, patients with atypical presentation require a high index of suspicion and meticulous evaluation.

Objective: This case report describes atypical presentation of haematometrocolpos in a pubescent Nigerian female.

Methods: A case of acute urinary retention in an adolescent girl, due to haematometrocolpos, is presented. A 13-year-old supposedly premenarcheal girl presented at the Children Emergency Unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria with acute urinary retention of twelve hours' duration. There was no preceding history of difficulty with voiding. About 1,200mls of urine was drained from the bladder with a self-retaining catheter. Examination revealed an 18-week-sized cystic abdomino-pelvic mass, and the vagina was closed with a bulging membrane at the introitus. Abdomino-pelvic ultrasonography revealed a distended uterus containing fluid with low level echo, typifying the ground-glass appearance. Trans-hymenal ultrasonography using a 2.5-7.5MHz endocavitary probe confirmed a ballooned-out vagina with similar content, with a 2mm thick hymen at the distal end.

Results: Hymenectomy was performed with spontaneous drainage of the menstruum. She was discharged after successful trial of voiding without catheter.

Conclusion: Though uncommon, haematometrocolpos from lower genital obstruction should be considered as a differential diagnosis of lower urinary tract obstruction in pubescent girls. Trans-hymenal ultrasonography is accessible and accurate for assessing the level of obstruction and the thickness of the intervening tissue.