Hymenal atresia presenting as acute urinary retention in an 11-year-old girl: a case report

Hymenal atresia is a rare congenital anomaly of the female genital organs, typically diagnosed in adolescence after menarche. In some cases, diagnosis is challenging due to nonspecific symptoms that may mimic diseases of other organs and systems. This article presents a clinical case of an 11-year-old patient who had painful urination for one week. In the last 24 hours, she was unable to urinate on her own. She was taken by ambulance to N.F. Filatov Children’s City Clinical Hospital in Moscow. Initial evaluation revealed no obvious urological cause, necessitating further diagnostic workup. Medical history (absence of menarche), gynecological examination, and ultrasound revealed a dilated vagina filled with menstrual blood (hematocolpos), identified as the main cause of urethral compression and acute urinary retention. The underlying condition was congenital hymenal atresia. A urethral catheter was placed, draining 750 mL of urine. On the following day, cruciate hymenotomy under general anesthesia evacuated 300 mL of hemorrhagic content, followed by vaginal sanitation. A Foley catheter was inserted and removed on postoperative day 3. The patient received a short course of antibiotic therapy in the postoperative period. Urination was restored. She was discharged on postoperative day 5 in satisfactory condition under pediatric gynecologist supervision. This case may help raise awareness among surgeons about the possibility of imperforate hymen in adolescent girls presenting with urinary retention and periodic lower abdominal pain. In our case, gynecological examination and pelvic ultrasound confirmed hematocolpos and enabled timely surgical management.