Concomitant Imperforate Hymen and Transverse Vaginal Septum Complicated with Pyocolpos and Abdominovaginal Fistula

Concomitant Imperforate Hymen and Transverse Vaginal Septum Complicated with Pyocolpos and Abdominovaginal Fistula

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A 13-year-old patient with a complaint of worsening lower abdominal pain during the Dishwasher Basket Clips past 4 months was admitted to the emergency department.An abdominopelvic ultrasound scan revealed a distended uterocervical cavity suggestive of hematometrocolpos.Imperforate hymen was observed on examination of the external genitalia.MRI scan revealed an air-fluid level representing pyometrocolpos within a distended vagina.

Posterior vaginal extraperitoneal leakage as the sign of a fistula between the vagina and the rectovaginal space was detected.Although laparoscopic approach was planned, malodorous pus expelled after the insertion of the Veress needle, it was decided to Marvel - other proceed to laparotomy.Pus with peritoneal microabscess formations was observed at laparotomy.The imperforate hymen and TVS were excised vaginally.

A more complex anomaly should be suspected in cases with hematometra and concomitant imperforated hymen without any bulging and thorough evaluation using radiological imaging techniques should be performed before surgical approach.