Acute Urinary Retention and Hematometra Secondary to Imperforate Hymen in 14-Year-Old Girl: A Comprehensive Case Report

Abstract

Imperforate hymen is a rare congenital obstructive anomaly of the female genital tract that is usually recognised after menarche, when retained menstrual blood causes haematocolpos and haematometra. Patients commonly present with cyclical lower abdominal pain, primary amenorrhoea or an abdominopelvic mass; urinary retention may occur when the distended vagina compresses the bladder neck and urethra. We report a 14-year-old girl with progressively worsening lower abdominal pain for 15 days and acute urinary retention for 2 days, requiring emergency transurethral bladder catheterisation. Examination revealed a firm, smooth abdominopelvic mass corresponding to a 22-week gravid uterus and a tense, bluish, bulging membrane at the vaginal introitus, consistent with an imperforate hymen. Transabdominal ultrasonography demonstrated marked distension of the vagina and cervix by a homogeneous, avascular fluid collection measuring 12 × 10 × 6 cm, with elevation of the normally sized uterine body. Emergency cruciate hymenotomy was performed under general anaesthesia, resulting in the drainage of approximately 550 mL of thick, dark, altered menstrual blood. The abdominal pain and urinary retention resolved after surgery, and the patient voided normally following catheter removal. She was discharged in a satisfactory condition with oral antibiotics, analgesia and follow-up advice. Imperforate hymen should be considered in adolescent girls presenting with primary amenorrhoea, cyclical abdominal pain, a pelvic mass or acute urinary retention, because timely diagnosis and surgical treatment can relieve obstruction and reduce the risk of delayed complications.