Hematocolpos on Hymeneal Imperforation: A Case Report and Literature Review on Hymeneal Imperforation:

: Hymenal imperforation is a rare birth defect. It produces a vulvar obstruction responsible for vaginal retention of menstrual blood. Its diagnosis and management must be early in order to preserve the subsequent fertility of the patients. Material and Methods : We report a case of hematocolpos on hymenal imperforation hospitalized in the obstetric gynecology emergency department of the Souissi Maternity Hospital in Rabat in September 2019. The aim of our work was to analyze the diagnostic and therapeutic features of this pathology. Results and Discussion : It emerges from this work that this anomaly is the prerogative of patients in the peri-pubertal period. The spectrum of clinical signs is dominated by abdominopelvic pain, the existence of abdomino-pelvic swelling and urinary complications such as acute urine retention, pollakiuria and dysuria. The diagnosis is mainly clinical by the discovery of perineovulvar swelling on genital examination, it is guided by ultrasound. Surgical treatment is simple. It is carried over an incision of the obturating membrane and drainage of the collection. Revision surgery is necessary in the event of hymenal restenosis. Conclusion : Systematic screening for hymenal imperforation at birth and its early diagnosis in the face of painful primary amenorrhea can prevent its complications. Hematocolpos A Case Report and Literature Reviews.


Introduction
Hymenal imperforation is a rare malformation that has been described for the first time by Ambroise Paré in 1633 [1]. It causes an obstruction of the vulvar orifice responsible for vaginal retention of menstrual blood at puberty which called: "hematocolpos". Its diagnosis seemed easy from birth by systematic screening, is

Materials and Methods
The clinical case is a 14 years old girl with a low social economic level, she had admitted to emergency for abdominopelvic pain, she had no medical history. there is no signs of urinary tract or digestive problems. General examination Find a conscious patient who is hemodynamically stable. Abdominal without stenosis. We dilated the orifice once a week for 1 month, then, once / 15 days, then once / month for 3 months. The patient was followed regularly for a year in consultation, then was lost to follow-up (Figures 1 & 2).

Results and Discussion
Clombus described for the first time in 1559, the congenital absence of the vagina. -During the tenth century Soranus and Delphus described cervical atresia [2]. -Hymenal imperforation was first described by Ambroise Paré in 1633 [1] -Hippocrates and Celsus [2,3], reported a case of vaginal obstruction by hymenal imperforation with secondaryhematocolpos. Hymenal imperforation has a frequency of 0.1% with the presence of familial cases [4]. Puberty remains the most frequent period of the hematocolpos diagnosis. The diagnosis of hymenal imperforation is possible in utero with an ultrasound finding of hydrometrocolpos [5,6]. in utero diagnosis also has the advantage of looking for associated renal malformations. This diagnosis can be made by a systematic screening at birth but also before a hydrometrocolpos during the genital crisis of the newborn female [7]. Most often, this malformation is discovered at puberty. The diagnosis must be suspected in a young girl presenting with primary amenorrhea with normally developed secondary sexual characteristics. Our patient was not yet menarche but had good development of the external genitalia, and secondary sexual characteristics. Patients usually consult for recurrent pelvic pain secondary to the accumulation of blood in the vagina or hematocolpos [8,9].
The cyclic nature of painful attacks may be lacking given the usual irregularity of the menstrual cycle during the peripubertal period [9]. The pain can be deceptive, pseudo-appendicular and induce "excess" interventions for suspected acute appendicitis [10].
Hematocolpos can compress the urethra and cause dysuria, complete bladder retention or even bilateral ureterohydronephrosis [8,[11][12][13][14][15]. Einsenberg [16] reported through a series of 44 observations of hematocoplos, 7 cases of bladder retention. Constipation comes from the same compressive mechanism [17]. Our patient presented with pelvic pain but did not report any signs of bladder or digestive compression. The blood is retained first in the vagina, then the uterus (hematometry) and possibly the tubes [18,19]. Its volume varies from patient to patient and can even reach 3 liters [20][21][22].
In case of diagnostic doubt, ultrasound may be helpful in showing the hematocolpos as a midline, retrovesical fluid-tone image containing a few heterogeneous echoes. This collection is surmounted by the communicating uterine cavity, which is often small, dilated by fluid content in the event of hematometry [23,24].
Renal agenesis is systematically sought, especially in cases of genital duplication [5]. Ultrasound may also show ureteropyelocalicular dilation in the event of compression of the urinary tract by hematocolpos [26,27]. In our patient, an abdominopelvic ultrasound was performed and revealed an intra-vaginal fluid collection in favor of hematocolpos. The antenatal ultrasound at 20 weeks of amenorrhea shows a collection image in the small pelvis, behind the bladder, but this mass can have several etiologies (anterior sacrococcygeal tumor, anterior sacral meningocele, ovarian cyst) [28,29]. Around 24 weeks of amenorrhea, following the development that the diagnosis asserts, the anterior sacral meningocele and the sacrococcygeal teratoma will develop towards the caudal region, while the ovarian cyst and hydrocolpos develop towards the cranial region [29]. The sex will be visible on this date, and the shape of the collection that will evoke the diagnosis. Endometriotic transplants: This is a transplant of endometrial cells from menstrual tubal reflux into the pelvic peritoneum or ovary.
Audbert reports a case of hematocolpos on hymenal imperforation with ovarian endometriosis and diffuse pelvic grafts [32].

Conclusion
Hematocolpos on hymenal imperforation is a rare condition which must be mentioned before any acute abdomino-pelvic pain syndrome or pelvic mass of the girl in the puberty period not yet regulated, especially as the pains are cyclical and the development of characters secondary sex is normal. It is an often benign condition, of favorable evolution, if it is diagnosed and treated early. Conversely its ignorance, exposes to serious complications.
Imaging guide the diagnosis, look for any associated uro-genital malformations and signs of compression, especially urinary tract. The treatment is exclusively surgical. Prevention by careful examination of the genitals at birth is possible.