HEMATOCOLPOS HEMATOMETRA PDFJuly 11, 2020
Imperforate Hymen Presenting with Massive Hematometra and Hematocolpos: A Case Report . Figure 2: Evacuation of hematocolpos and heamatometra. Hematometra a nd Hematocolpos: Ultrasound. Findings. x/79/ lolo. $ JOACHIM. F. SAILER’. An imperforate hymen is the most. A large hematometra and hematocolpos were detected by transabdominal ultrasound scanning. Transabdominal ultrasound depicted a distended uterus 90 mm.
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Hematocolpos – Wikipedia
Hematometrocolpos is accumulation of blood in the vagina and uterine cavity due to intra-uterine hemorrhage. A year-old female presented to our clinic with massive menorrhagia at menarche after progestin usage.
Hematometrocolpos was detected by transabdominal ultrasonography.
She was pale because of heavy bleeding for 5 days and hemoglobin level was measured as 5. Initial treatment was blood transfusion and medical drug therapy. After resolution of the hematometrocolpos was shown by transabdominal ultrasound 2 days later, the patient, who was stable, was discharged without complication.
Obstruction of the female genital outflow tract is rarely seen. Hematocolpos has been reported in elderly women following vaginal occlusion due to radiotherapy, vaginal fibroma and labial synechiae causing infection or inflammatory conditions. The case is presented here because of the successful management of hematometrocolpos due to massive dysfunctional uterine bleeding in a young virgin patient.
In addition, it is very important to understand the difference between non- life-threatening bleedings and those requiring emergent intervention [ 4 ]. Therefore, a careful anamnesis, and physical examination are essential for diagnosis and management. Uterine bleedings due to obstruction of the lower female genital tract cause proximal dilatation and the occurrence of hematocolpos, hematotrachelos or hematometra are the most common problems defined as congenital abnormalities [ 456 ].
Obstruction of the female genital outflow tract is rare [ 78 ]. The case is presented here because of successful management of hematometrocolpos due to massive dysfunctional uterine bleeding in a young virgin patient.
A year-old virgin patient with an episode of massive menorrhagia at menarche was admitted to the Emergency Room ER of the Department of Obstetrics and Gynecology. Her medical history revealed that 15 days prior to the presentation at the Emergency Department, she had been prescribed a ten-day course of progestogen therapy on request to delay her menstrual cycle. She had no known bleeding disorders. Her gynecological history included menarche at 14 years of age.
Her periods lasting for 6 henatometra 7 days were normal and regular occurring at day intervals. Her abdomen was soft, with moderate tenderness of the lower abdomen without rebound. Pelvic examination revealed an intact annular hymen. The hymenal opening was mm in diameter. Coagulated blood bulging outwards from the hymen opening was observed.
A large hematometra and hematocolpos were detected by transabdominal ultrasound scanning. Transabdominal ultrasound depicted a distended uterus 90 mm in diameter Figure 1a which communicated with a markedly distended vagina Figure 1b. Both ovaries were observedly normal. She had been bleeding heavily for 5 days causing a drop in hemoglobin level down to 5. Pregnancy test was negative. She was initially treated with blood transfusion eight units of packed red blood cells and four units of packed fresh-frozen plasma were transfused and hemostasis was achieved rapidly using high doses of combined oral contaceptive ethinyl estradiol 0.
After one day, a chocolate-like fluid started to spill out from the vagina. A transabdominal ultrasound obtained 2 days later showed resolution of the hematometrocolpos. The patient was discharged without complication. A Transabdominal sagital ultrasonographic view showing the markedly distended uterus. Heterogeneous structures the largest being 90 mm in diameter hemmatocolpos seen in the hematocolpoe cavity. B Transabdominal sonographic view showing the markedly distended vagina measuring Heterogeneous structures the largest being 90 mm in diameter were seen in the vaginal cavity.
Congenital abnormalities resulting in hematometrocolpos include imperforate hematojetra, a complete transverse vaginal septum, vaginal and, rarely, cervical atresia [ 789 ]. Acquired obstruction of the lower female genital hematcolpos is rare. These acquired problems are caused by iatrogenic interventional traumas to the uterine cervix such as cone biopsies, hematkmetra electrosurgical procedures, dilation and curettage, obstetric lacerations, cervical or endometrial carcinoma, and radiation therapy [ 91011121314 ].
Spontaneous obstruction is generally uncommon but has been reported recently [ 15 hemattocolpos. About one fifth of females presenting with heavy menstrual periods may hsmatocolpos an underlying blood dyscrasia [ 2151617 ]. HMB may be associated with a variety of endocrine disorders such as thyroid disease, adrenal problems and other medical problems such as hepatitis, chronic renal disease or diabetes mellitus.
In addition, HMB episodes may occur because of disruptions or abnormalities of the coagulation cascade [ 1 ]. In the present case, sonographic findings demonstrated acquired obstruction of the lower female genital tract, specifically hematometra and hematocolpos. The intracavitary findings included different degrees of resolving hemorrhage, but a malignancy, although less likely, could not be hematomeetra out.
However, presenting symptoms of hematometra and hematocolpos without any evidence of primary and secondary amenorrhea were considered to be related to massive uterine bleeding following the use of progestin fifteen days previously. In the present case, it was thought that massive uterine bleeding could have caused an obstruction secondary to the clot hematpmetra. Narrow diameter of the hymenal opening may have facilitated this process.
There are some effective treatment methods for adolescents with HMB. Planning is very important in the treatment of both acute bleed and its maintenance therapy.
Intravenous crystalloid infusion for the replacement of the blood volume may be given to a patient with an acute HMB episode which is causing anemia [ 19 ]. For adolescents already using combined oral contraceptives COCs and admitted jematometra HMB despite treatment, transition to i. There is not enough data as yet to recommend one specific type of COC over any other [ 21 ]. Antifibrinolytics have the effect of halting the lysis of heatometra occurring at the end of the clotting cascade thus improving the clotting process.
Antifibrinolytics have been reported to decrease bleeding in about half of the women with HMB and can be administered in combination with contraceptive methods [ 20 ].
Current studies have also shown that NSAIDs decrease menorrhagia in adolescents compared to placebo mg daily [ 22 ].
Imperforate Hymen Presenting with Massive Hematometra and Hematocolpos: A Case Report
The underlying etiology of the acquired obstructed cervix in the patient presented here is not as yet fully understood.
Potential etiologies include progestin use, decreased uterine contractility triggered by high progestin levels, which might have prevented the effective removal of menstrual debris, and lastly, a possible partial obstruction causing massive uterine bleeding and drainage of bleeding around a solid obstruction.
Decreased drainage of accumulated debris rather than acute hemorrhage may have caused hematometrocolpos. Thus, the underlying etiology of the obstruction in this patient was uncertain, and this case denotes an unusual cause of acquired spontaneous hematocolpod and hematocolpos developed following progestin use. Adolescents often present at gynaecologists hemato,etra HMB, although HMB following the usage of contraceptive pills which may cause hematometrocolpos is rare.
The diagnosis and treatment of this situation includes a careful hemaotcolpos, and ultrasonographic examinations, and laboratory tests to exclude other diagnoses hematovolpos as bleeding disorders, anatomic and endocrine causes.
Treatment methods include hormonal therapies, antifibrinolytics and nonsteroidal anti-inflammatory drugs, which are effective, well-tolerated and safe. This case shows that a careful history and examination is very hematocolpod in the recognition of a rarely seen life-threatening menorrhagic episodes arising from usage of progestin with the intention to delay the menstrual cycle.
Written informed consent was obtained from the patient who participated in this study. No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support. National Center for Biotechnology InformationU. Journal List North Clin Istanb v. Published online Aug 3. Author information Article notes Copyright and License information Disclaimer. Received May 26; Accepted Aug This article has been cited by other articles in PMC.
Abstract Hematometrocolpos is accumulation of blood in hematkcolpos vagina and uterine cavity due to intra-uterine hemorrhage. Hematocolpospelvic massprogestin. Open in a separate window. Conclusion Adolescents often present at gynaecologists with HMB, although HMB following the usage of contraceptive pills which may cause hematometrocolpos is rare.
J Pediatr Health Hematoolpos. Bleeding disorders in teenagers presenting with menorrhagia. Menorrhagia in adolescents with inherited bleeding disorders.
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An hematocolpo late presentation of imperforate hymen. Treatment of hematotrachelos after dilatation and curettage.
Hematocolps and extended vaginal haematoma after laser conization. Eur J Gynaecol Oncol. Scheerer LJ, Bartolucci L. Transvaginal sonography in the evaluation of hematometra. A report of two cases. Transvaginal sonography of hematotrachelos and hematometra causing acute urinary retention after previous repair of intrapartum cervical lacerations. Pschera H, Kjaeldgaard A. Haematocervix after conization diagnosed by ultrasonography.