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Neonate with Abdominal Lump and Anuria
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... It mostly presents during puberty although diagnosis in utero and during newborn period and childhood are also documented in the literature. [4][5][6][7] It can present during the neonatal period as abdominal mass, urinary tract obstruction, hydroureteronephrosis and can rarely mimic abdominal ascites. [8,9] Imperforate hymen needs to de differentiated from urethral prolapse or prolapsed ureterocoele as the diagnosis poses difficulties on clinical bases. ...
... [8,9] Imperforate hymen needs to de differentiated from urethral prolapse or prolapsed ureterocoele as the diagnosis poses difficulties on clinical bases. [6] Surgical approach for imperforate hymen is from perineum whereas urogenital sinus and vaginal atresia need complex management. Genitoscopy, genitogram and sometimes initial laparotomy is needed. ...
... Urethral prolapse and prolapsed ureterocoele can also mimic imperforate hymen. [6] Most of cases of the imperforate hymen present during puberty although diagnosis in utero and neonates and infancy are also documented. [1,3,7,8] The incidence of imperforate hymen is 0.014-1%. ...
Neonatal hydrometrocolpos is a rare abnormality and can present as an abdominal mass, urinary tract obstruction, anuria, hydroureteronephrosis, constipation or respiratory distress. Hydrometrocolpos in neonate can be due to imperforate hymen, vaginal atresia, vaginal septum, urogenital sinus or even cloaca. Clinical examination and routine ultrasonography cannot differentiate causes of hydrocolpos in all such cases. Surgical approach depends upon the underlying cause of hydrometrocolpos. We report an unusual case of neonatal hydrometrocolpos in which it was extremely difficult to differentiate urogenital sinus from imperforate hymen or vaginal atresia. The patient underwent magnetic resonance imaging (MRI) which clearly showed the imperforate hymen and was helpful in planning management of the case. Hence, there is the definitive role of MRI in the differential diagnosis of hydrometrocolpos and is equally helpful in making surgical decisions.
Hydrometrocolpos is the result of an obstruction of the genital tract by an intact hymen, a midplane transverse septum, cloacal anomalies or vaginal atresia. This obstruction allows an accumulation of secretions from the infant cervical mucous glands in the vagina and uterus stimulated by maternal oestrogen (Wilson et al, 1978; Nyberg, 1990).
The incidence is reported to be between one in 16 000 births (Westerhout et al, 1964) and one in 30 000 births (Hill & Hirsch, 1985). Although several cases of hydrometrocolpos have been reported in the world literature (Mahoney & Chamberlain, 1940; Spencer & Levy, 1962; Reed & Griscom, 1973), there are very few reports of the ultrasonographic appearances of this condition (Sailer, 1979; Sawhney et al, 1990).
We present two cases of hydrometrocolpos which showed classical ultrasound features and review the literature on the subject.
A 1-day-old white girl, the product of a normal pregnancy and delivery, presented with a fluctuating mass protruding from the vagina. Clinical examination revealed a palpable abdominal mass and a swollen labia. An ultrasound of the abdomen and pelvis was performed using a 5 MHz probe. A 6 cm × 4 cm cystic left adnexal mass was demonstrated with no posterior acoustic enhancement. The mass contained several internal echoes (Fig. 1). The bladder was not distended and therefore not seen, but both kidneys were normal. The vaginal membrane was incised and 150 ml of milky white fluid was expelled.
Imperforate hymen is most commonly an isolated finding and usually remains asymptomatic until puberty. Rarely, symptoms of imperforate hymen manifest antenatally as well as in the neonatal period, requiring surgical correction for life-threatening consequences. We report a 5-day-old infant with a large hydrometrocolpos causing severe renal compromise and abdominal ascites, successfully surgically treated in the neonatal period. Associated polydactyly suggested McKusick-Kaufman syndrome. © 2006 North American Society for Pediatric and Adolescent Gynecology.
Congenital obstructing lesions of vagina, hydrometrocolpos, and hematocolpos, present at a variable time during early childhood and adolescence to different medical and surgical specialties. Twenty-six cases presenting over an 18-years period (1987-2005) were divided into three groups; Group A: neonates (6), Group B: adolescents (18), and Group C: adults (2). Common presentations in neonates (Group A) were abdominal mass (5), neonatal sepsis (3), and respiratory distress (2); whereas abdominal pain (18), voiding dysfunctions (13), and backache (7) were prevalent in adolescents (Group B). Adults (Group C) presented with inability to consummate and infertility (2). Four patients received erroneous treatment; exploratory laparotomy (1) and appendectomy (3). Urinary symptoms and associated urinary abnormalities were present in more than 50% of cases, especially those with complex anomalies. Management included excision of imperforate hymen (16) and transverse vaginal septum (8) through perineal (20) and abdominoperineal approach (4). Patients with urogenital sinus (1) and cloacal malformation (1) had staged reconstruction at 2.5 years of age following preliminary vesicostomy and colostomy at birth. On follow up (range 1-15 years; mean 7) more than 60% patients have menstrual irregularity (11), endometriosis (5), and infertility (4). In conclusion, rarity and variable presentation of congenital vaginal obstructions can lead to delayed diagnosis and erroneous management. A high index of suspicion and cross-sectional imaging help in early diagnosis and associated renal anomalies. A comprehensive management is imperative to preserve the reproductive potentials, as significant proportion of patients may experience sexual difficulties, menstrual irregularity, and infertility.