| Abstract|| |
Imperforate hymen is a rare diagnosis in the neonatal period. Bilateral hydronephrosis and renal failure are rare complications of an imperforate hymen. We present the case of a newborn with undiagnosed imperforate hymen complicated with renal failure.
Keywords: Imperforate hymen, Hydronephrosis, Renal failure.
|How to cite this article:|
Hijazeen R. Imperforate Hymen with Bilateral Hydronephrosis in a Neonate. Saudi J Kidney Dis Transpl 1998;9:33-5
| Introduction|| |
An imperforate hymen is a relatively rare condition, occurring in 1:3000 women. The diagnosis is usually made following menarche when the normal menstrual outflow tract is blocked.
In the neonatal period, imperforate hymen can result in hydrocolpos (vagina distended with fluid) or hydrometra (distension of the uterus). Both conditions are due to accumulation of excessive cervical and/or vaginal secretions and they often co-exist as hydrometrocolpos. Rarely hydrocolpos or hydrometrocolpos may produce intestinal obstruction or hydronephrosis by pressure upon contiguous structures. We present the case of a three-day old girl who presented with renal failure and was found to have whitish cystic mass protruding from the introitus.
| Case Report|| |
A five-day old girl, born after full-term normal delivery, was admitted to the King Hussein Medical Center, Amman, Jordan for evaluation of diarrhea, rapid breathing and poor feeding. Physical examination revealed a tachypneic girl with palpable suprapubic abdominal mass, normal external female genitalia with bulging whitish cystic mass from the introitus, suggestive of bulging hymen. Laboratory work-up revealed hemoglobin of 142 g/L, total white blood cells count of 13,300/cu mm, platelet count of 248, 000/cu mm and ESR of 12 mm in the first hour. Serum sodium was 130 mmol/L, chloride 101 mmol/L, BUN 23.2 µmol/L (65 mg/dl), creatinine 309 µmol/L (3.5 mg/dl) and glucose 4.2 mmol/L (75 mg/dl). Blood gases were suggestive of metabolic acidosis with serum pH of 7.10 and bicarbonate of 7 mmol/L. Plain X-ray of the abdomen showed displacement of the bowel. Abdominal ultrasound revealed a cystic mass measuring 10 x 12 cm compressing the bladder anteriority, with bilateral hydroureters and hydronephrosis. The infant underwent hymenotomy and drainage of retained secretions. Blood gases, electrolytes, BUN and creatinine were normal three days later. Repeat abdominal and pelvic ultrasound and micturating cystogram three weeks later were normal.
| Discussion|| |
When the hymen of a newborn infant is imperforate the condition often escapes detection and does not become evident until the features of hematocolpos occur at puberty. A minority of newborn infants with imperforate hymen may, however, present for treatment during the first few days of life. The condition is known as hydrocolpos  . Above the imperforate hymen the vagina becomes distended with varying amounts of watery, or usually milky fluid which collects there as a result of the passive stimulation from maternal hormones which have crossed the placenta to the fetus in-utero. The quantity of fluid which collects may vary from a few milliliters to large volumes. If a large quantity of fluid is present there may be retention of urine and abdominal swelling. Inspection of the vulva usually reveals a bulging membrane, and the diagnosis can be readily made  .
Imperforate hymen usually occurs sporadically but can be familial  . If found in isolation, it is rarely associated with other anomalies. This is in contrast to vaginal atresia which is usually associated with other congential anomalies, such as fistulas, imperforate anus, bicornuate uterus, renal hypoplasia, and polydactyly , . The diagnosis should be made on physical examination. An abdominal mass along with bulging whitish mass seen at the introitus in the neonatal period should alert the pediatrician to the diagnosis of imperforate hymen. The normal vaginal orifice is difficult or sometime impossible to visualize  . Ultrasound is very helpful in ruling out other associated anomalies  .
The treatment of imperforate hymen is hymenotomy under aseptic techniques in the operating room. A cruciate type of incision is made in the membrane, the excess tags are excised as in hydrocolpos and no further treatment is necessary  .
In summary, while imperforate hymen is a rare condition, the key for making the diagnosis is to consider the diagnosis in a newborn with abdominal mass and a bulging whitish mass from the introitus. Obstructive uropathy may result form bladder compression by the hydrocolpos. Prompt diagnosis and treatment is vital to prevent subsequent complications , .
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Consultant Pediatrician, King Hussein Medical Center, P.O. Box 950288, Amman