281 JNMA I VOL 52 I NO. 5 I ISSUE 189 I JAN-MAR, 2013 Cervical Dysgenesis with Transverse Vaginal Septum with Imperforate Hymen in an 11 year old Girl Presenting with Acute Abdomen Pratiksha Gupta, 1 Sangeeta Gupta, 1 Sunita Jindal, 1 Kanwaljeet Chopra, 2 Manjari Sinha, 1 Anita Arora 2 1 Department of Gynaecology and Obstetrics, 2 Department of Paediatrics, Post Graduate Institute of Medical Sciences and Research, ESICH, Basaidarapur, New Delhi. ABSTRACT This case highlights the importance of careful evaluation of girls presenting with imperforate hymen as this is accompanied by other female reproductive tract anomalies. It is of utmost importance that a correct timely diagnosis is made so that the right treatment can be chosen with the perspective of future fertility. Cervical dysgenesis associated with vaginal septum and imperforate hymen has not been reported in literature so far. Present case highlights the simple mode of management with a successful outcome. _______________________________________________________________________________________ Keywords: cervical dysgenesis; imperforate hymen; transverse vaginal septum. _______________________________________________________________________________________ ______________________________________ Correspondence: Dr. Pratiksha Gupta, Department of Gynecol- ogy and Obstetrics, Post Graduate Institute of Medical Sciences and re- search, ESIC, Basaidarapur, New Delhi. Email: drpratiksha@gmail.com, Phone: +919871128703. INTRODUCTION Female reproductive tract abnormalities are generally encountered in 2% to 3% of women. 1 Imperforate hymen is the most common obstructive defect, with a reported incidence varying from 1:1000 to 1:16,000 female births. Transverse vaginal septum is rarer with an incidence of 1:21,000 to 1:72,000 women and may lie on the upper, middle, or lower third of the vagina with a relative incidence of 46%, 35%, and 19%, respectively. Both these situations causes obstruction of the female genital tract, it becomes symptomatic during newborn period and infancy leading to mucocolpos, and more often after menarche resulting in haematocolpos and haematometra. Congenital cervical agenesis with or without vaginal agenesis is a rare Mullerian developmental disorder that occurs in one in every 80,000 to 100,000 births. 2 CASE REPORT An 11 years old girl reported to the department of Pediatrics on fourth march 2012, with acute lower abdominal pain and pain during micturition since one day. Patient was apparently well two months back when she developed off and on pain in lower abdomen, with no radiation, mild in intensity, increased during micturition and relieved by medication. One day prior to admission, she developed severe pain in suprapubic and infraumbilical region with no radiation, continuous and severe in intensity, got aggravated during micturition and was not relieved by any medication. General examination was within normal limits. She had normal secondary sexual characteristic with normal development of the breast and pubic hairs (Tanner II stage). On abdominal examination, lower abdominal tenderness was present. Examination under anesthesia revealed the hymen to be replaced by a thin membrane like structure. On per rectal examination, vagina was felt all through its length, a bulky, tender 6cm X 6cm tensely cystic mass above the vagina and anterior to the rectum was felt. A probable diagnosis of haematometra with imperforate hymen was made and was planned CC S BY NC OPEN ACCESS CASE REPORT J Nepal Med Assoc 2013;52(189):281-4