http://dx.doi.org/10.5455/2320-1770.ijrcog20140965 Volume 3 · Issue 3 Page 839 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Rathod S et al. Int J Reprod Contracept Obstet Gynecol. 2014 Sep;3(3):839-842 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Case Report Imperforate hymen and its complications: report of two cases and review of literature Setu Rathod, Sunil Kumar Samal*, Anandraj Rajsekaran, P. Reddi Rani, Seetesh Ghose INTRODUCTION Imperforate hymen is the commonest female genital tract malformation and is noted in approximately 1 in 2000 females. 1 Although the most common age of presentation is around puberty 2,3 diagnosis in utero 4-6 and during the new born period and childhood 4,7 are also reported. We report two cases of imperforated hymen with different symptoms of presentation. CASE REPORT Case 1 A 14 year old girl presented with colicky lower abdominal pain and acute retention of urine for one day. She had not attended her menarche but had developed secondary sexual characters. There was history of cyclical colicky lower abdominal pain with backache for which she took medication from local hospital. For last one month there was increased frequency and difficulty in micturition. Although she had reduced appetite and poor intake of food due to colicky pain, there was no history of constipation, diarrhoea, vomiting or fevers. She was catheterised with an indwelling Foleys catheter and one litre of straw coloured urine was drained. Abdominal examination revealed, pain and tenderness in lower abdomen with a suprapubic mass corresponding to a uterus at 14 weeks. Examination of external genitalia revealed a bulging bluish colour imperforate hymen (Figure 1) which was exaggerated on valsalva manoeuvres. The mass was found to be anterior to rectum in per rectal examination. Pelvic ultrasonography revealed distended uterus and vagina all filled up with homogenous thick fluid with internal echos (Figure 2). She was diagnosed as a case of hematometra and hematocolpos with imperforate hymen and planned for Department of Obstetrics & Gynecology, Mahatma Gandhi Medical College & Research Institute, Pillaiyarkuppam- 607402, Pondicherry, India Received: 28 July 2014 Accepted: 8 August 2014 *Correspondence: Dr. Sunil Kumar Samal, E-mail: drsksamal1981@gmail.com © 2014 Rathod S et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Imperforate hymen is a rare female genital tract malformation, arises as a result of complete failure of the inferior end of the vaginal plate to canalize. We report two cases of imperforate hymen with different presentation. Our first case was a 14 year old girl presented with lower abdominal pain and acute retention of urine with history of cyclical lower abdominal pain for last 6 months. Examination revealed mass of 14 weeks gravid uterus with bulged imperforate hymen. The second case was a 16 year old girl presents with primary amenorrhoea with mass per abdomen. There was history of difficulty in micturition and constipation for last 4 months. On examination, a mass of size corresponding to 22 weeks gravid uterus with bulged bluish colour imperforate hymen was found. Both the cases were managed with incision and passive drainage of collected menstrual blood. On follow up both the cases resumed menstruation and doing well. Keywords: Imperforate hymen, Primary amenorrhea, Acute urinary retention DOI: 10.5455/2320-1770.ijrcog20140965