A 13 -- years -- old young girl presents in the casualty with acute pain in the lower abdomen. She has history of cyclical pain for last 6 months and she has not attained her menarche yet. On local genital examination, a tense bulge in the region of hymen was seen. The most probable diagnosis is :
Ans. is c i.e. Imperforate hymen A young girl who has not attained menarche but has history of cyclical pain for last 6 months, presenting to casualty with acute abdomen and on examination a tense bulge in the region of hymen - clearly point towards "Imperforate hymen" as the diagnosis. Imperforate Hymen : It is the most common cause of cryptomenorrhea. Patients (young girls) present at pubey with Primary Amenorrhea (actually cryptomenorrhea) having not attained menarche. Secondary sexual characteristics are normal. Pathology : In such patients there is cyclical shedding of endometrium and blood, (so, patients give H/0 cyclical pain), which keeps accumulating in the uterine cavity resulting in hematometra. In neglected cases it may lead to distension of tubes Le. hematosalpinx. Patient may present with colicky pain in abdomen, pelvic discomfo or rectal pain. Hematocolpos can cause pressure symptoms like difficulty during micturition which finally ends up with urinary retention. On examination : A tumor, dull on percussion is found in lower abdomen (This could paly be due to distended vagina and uterus and paly by an overfill bladder with hyperophied wall). On separation of labia, bluish bulging membrane is present. Management : Once the diagnosis is made surgical treatment is urgently required, as every menstrual episode fuher dilates the genital tract and threatens permanent impairment of reproductive function. The hymen is incised by a cruciate incision and collected tarry blood is allowed to drain.
Mayer Rockitansky Kuster Hauser syndrome
Testicular feminization syndrome
Imperforate hymen
Ashermann's syndrome