Hematocolpos: Months-Long Mystery Revealed by Point-of-Care Ultrasound

A premenarchal female suffered recurrent abdominal pain for months before presenting to a critical access emergency department (ED), where point-of-care ultrasound (POCUS) finally revealed the underlying diagnosis of hematocolpos associated with imperforate hymen. Imperforate hymen, while rare, can lead to occlusion of the vaginal orifice during menarche, resulting in hematocolpos. Patients with hematocolpos can present with abdominal, low back, or pelvic pain, and delayed diagnosis may result in additional signs and symptoms, including tenesmus, constipation, urinary retention, and a palpable abdominal mass. Due to many potential etiologies of pediatric abdominal pain, attention to history of present illness and physical examination is critical to elucidate uncommon clinical diagnoses. POCUS is a safe, rapid, low-cost modality to evaluate the broad differential in pediatric abdominal pain. Early incorporation of POCUS may decrease diagnostic errors and patient morbidity associated with a delayed or inaccurate diagnosis.