MASSIVE HEMATOCOLPOS SECONDARY TO IMPERFORATE HYMEN IN A 15-YEAR-OLD ADOLESCENT

Background: Imperforate hymen is an uncommon congenital obstructive anomaly of the distal female genital tract that may remain clinically silent until puberty.Once menstrual cycling begins, retained blood can progressively distend the vagina, resulting in hematocolpos and, in advanced cases, a substantial abdominopelvic mass.Delayed recognition may expose adolescents to recurrent pain, urinary or bowel compression, infection, endometriosis and avoidable diagnostic procedures.Case presentation: This case was managed at Marwa Fertility Center, Mogadishu, Somalia, a major reproductive and gynecology center that provides fertility treatment and general gynecologic services.A 15-year-old girl presented with primary amenorrhea, recurrent cyclical abdominal pain lasting four to five days at approximately monthly intervals, and a 10-day episode of acute abdominal pain.She had no gastrointestinal or urinary complaints and no significant medical or surgical history.Secondary sexual characteristics were well developed (Tanner stage IV).Abdominal examination revealed a slightly tender midline lower-abdominal mass approximating a 25-week gravid uterus.Perineal examination showed an intact hymen and a 6 × 6 cm bulging membrane posterior to the urethra, accentuated by Valsalva manoeuvre, establishing the diagnosis of imperforate hymen with massive hematocolpos.Intervention and outcome: After written consent for surgery, urethral catheterization and hymenotomy were performed under general anaesthesia.A central incision was extended in a cruciate fashion, approximately 1,500 mL of thick, tarry old menstrual blood was evacuated, redundant hymenal tissue was excised, and the mucosal edges were everted and sutured.Culture showed no growth.The abdominal mass resolved immediately, recovery was uncomplicated, and the patient was discharged the following day.At six-week follow-up, normal menstrual flow had commenced.Conclusion: Primary amenorrhea with cyclic pain in a pubertally developed adolescent should prompt deliberate assessment for genital outflow obstruction, including respectful external genital examination.This case demonstrates that a clinically straightforward congenital anomaly can progress to massive hematocolpos when recognition is delayed, while timely definitive hymenal surgery can restore menstrual outflow with a favorable short-term outcome.