I didn't see the patient myself but when I heard it being presented in the morning prayers, I just had to at least go read the case note.
One of the common causes of primary amenorrhea, usually presenting with cyclical abdominal pain, like dysmenorrhea only without the menses. Easily missed diagnosis although easy to make.
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11yo female child with no menses yet presented with history of progressive abdominal distension for 2 months associated with abdominal and back pain. She has no fever and other constitutional symptoms.
Examination reveals an abdominal mass measuring a 24 week size uterus, which was mobile side to side and could not get below the mass.
Examination of the perineum clinched the diagnosis of imperforate hymen. Before this the differential was ovarian and uterine mass.
TAS shows hematometra and hematocolpos. (Something like below although this image was taken from medscape)
Hymenectomy was done. Surgery was uneventful and patient was discharged well the day after the surgery.
For more:
http://emedicine.medscape.com/article/954252-overview
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