Acute Urinary Retention due to Hematocolpos: A Case Report

Abstract

Acute urinary retention is an uncommon occurrence in the pediatric population, usually arising from a mechanical obstruction. It may result from hematocolpos, a gradual accumulation of menstrual blood in the vaginal cavity due to outflow tract disorders, with imperforate hymen being the most prevalent. Despite the simplicity of diagnosing and treating Imperforate Hymen, the occurrence of missed or delayed diagnoses is a common clinical challenge. This issue is attributed to the condition’s low incidence, the presence of nonspecific symptoms, or insufficient physical examinations. We present a case of a 16-year-old patient, presented to the emergency department with a one-day history of acute urinary retention. She had not yet begun menses, and reported a background of cyclical lower back-pain and discomfort during urination. After urethral catheterization, physical examination revealed a regular, resilient pelvic mass and the visual inspection of the external genital tract revealed a thick, bulging, and non-bluish hymen. An ultrasound scan confirmed the diagnosis of hematocolpos. She underwent a hymenectomy using a radial incision and made a good recovery postoperatively. Hematocolpos should be systematically sought in young girls with urinary symptoms and primary amenorrhea. If not managed at time, it may have devasting complication such as tubal adhesion, pelvic endometriosis, and infertility.