Imperforate Hymen

A Pediatric Surgery / O&G Interest

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.

--------------------------------------------

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

Polyhydramnios - Spectrums

I've decided to write on interesting cases here. In the future I'll decide if they would be included in the travelogue.

Polyhydramnios - Spectrums

Case 1

22yo Primid @ 26W + 3D

Late booker

Referred for further management of fetal anomaly seen in TA scan and reduced fetal movement.

Patient was aysmptomatic, not in labour. V/S were normal. Per abdomen SFH was 30W size, with difficulty to papate the fetal parts and positive fluid thrill. There were no contractions.

TAS revealed:

- Dilated fetal heart. Still beating.

- Fetal ascites.

- Empty mother's Morrison's pouch.

What are other TAS features to look for?

What is the probable diagnosis?

What are the investigations to be performed in this case?

--------------------------------

Case 2

28yo, G4P3 @ 38W+1D

Antenatal problems: Anemia in pregnancy, AFI normal throughout pregnancy, no GDM, fetal anomaly scan not done.

Came in active phase of labour.

V/S stable

PA: Ut size: 38W, singleton, cephalic, head 5/5 floating, difficult to plapate the fetal parts/

Admitted to labour room for controlled ARM. CTG was reactive prior to admission.

On rupturing the membrane, 1.5 L of liquor was drained with fresh blood stains. CTG worsened showing unprovoked decelerations.

Impression was placenta abruption secondary to ARM.

Posted for EMLSCS.

Intraoperatively uneventful.

Baby boy delivered with BW 2.1kg. Admitted to NICU for TTN. Later discovered to have tracheoesophageal fistula, imperforated anus. Planned for thoracotomy, TOF repair and colostomy my the peds surgery team.

Mother was well post-op.

--------------------------------

Maybe I'll write a bit on polyhydramnios when I'm a bit in the mood. I find both cases interesting. There was another with hydrops fetalis but I didn't note the case.

Other cases of polyhydramnios I'm on the lookout for are:

- diabetic causes

- Twin-twin transfusion

- Other fetal anomalies (ie. Spinal disorders due to problems swallowing)