American Journal of Pediatrics 2019; 5(4): 187-190 http://www.sciencepublishinggroup.com/j/ajp doi: 10.11648/j.ajp.20190504.13 ISSN: 2472-0887 (Print); ISSN: 2472-0909 (Online) Case Report Early Diagnosis and Successful Treatment of Congenital Huge Hydrometrocolpos Secondary to Low Transverse Vaginal Septum with Obstructive Symptoms Zelalem Ayichew 1 , Zerubabel Tegegne 2 , Mequanint Melesse 1 1 Department of Obstetrics and Gynecology, University of Gondar Hospital, Gondar, Ethiopia 2 Department of Radiology, University of Gondar Hospital, Gondar, Ethiopia Email address: To cite this article: Zelalem Ayichew, Zerubabel Tegegne, Mequanint Melesse. Early Diagnosis and Successful Treatment of Congenital Huge Hydrometrocolpos Secondary to Low Transverse Vaginal Septum with Obstructive Symptoms. American Journal of Pediatrics. Vol. 5, No. 4, 2019, pp. 187-190. doi: 10.11648/j.ajp.20190504.13 Received: May 28, 2019; Accepted: July 1, 2019; Published: September 18, 2019 Abstract: Obstructive congenital anomalies of the female reproductive tract are rare and usually noticed during adolescent period for failure to see menses with cyclic abdominal pain, abdominal mass and local compressive symptoms. It is very rare for such cases to be symptomatic during early childhood from mucous collection. Congenital hydrometrocolpos (an accumulation of watery fluid in the uterus and vagina) that occurs during fetal period is a very rare condition, only with some case reports. The diagnosis is challenging and usually made late which delays the management resulting poor outcome from local compressive symptoms. We present a case diagnosed with huge congenital hydrometrocolpos secondary to low transverse vaginal septum using ultrasound by experienced radiologist and meticulous genital examination in a 5 day old neonate who had abdominal distention and difficult to pass urine since birth where incision of the septum transvaginally and drainage of the fluid was done to relieve symptoms with successful outcome. Keywords: Congenital (Hydrometrocolpos), Transverse Vaginal Septum, Fetal Cystic Abdominal Mass, Neonatal Abdominal Mass with Obstructive Uropathy 1. Introduction and Literature Review Congenital anomalies of the female reproductive system are rare conditions which arise from failure of fusion of the mullerian duct or failure of resorption Obstructive genital tract anomalies usually manifest after age of menstruation with cyclic abdominal pain, lower abdominal swelling and local urinary or rectal compressive symptoms from the hematocolpometra. [1] Rarely they can be manifested in childhood from collection of mucous in the vagina and present with compressive symptoms. Hyperstimulation of the cervical glands by maternal hormones during fetal and early neonatal period could result in production of excessive cervical discharge and accumulation fluid in the vagina and/ or uterus giving a condition called hydrometrocolpos. Congenital hydrometrocolpos which usually occurs from imperforate hymen and rarely from distal vaginal atresia is a very rare condition with significant diagnostic challenge resulting in late diagnosis which delays management and increases mortality. [2] Antenatal diagnosis needs high index of suspicion by experienced radiologist using an ultrasound or MRI. Meticulous neonatal evaluation could help early diagnosis and treatment of such cases. The aim of treatment is distal vaginal drainage, which can be achieved by a perineal procedure in most cases. Laparotomy is indicated only in cases of high vaginal atresia, which require a vaginal pull-through procedure. [3]