A Clinical Pitfall: Imperforate Hymen Presenting as Abdominal Distension in an Adolescent

Authors : Mevlana Gül, Ayça Çalbay, Sümeyye Gündüz
Pages : 167-169
Doi:10.33706/jemcr.1787981
View : 66 | Download : 193
Publication Date : 2025-12-31
Article Type : Other Papers
Abstract :Introduction: Imperforate hymen is a rare congenital anomaly and the most common obstructive lesion of the female genital tract. Although classically presenting with primary amenorrhea and cyclic pelvic pain, atypical manifestations such as progressive abdominal distension may mimic gastrointestinal, urinary, or malignant conditions and delay diagnosis. Case Presentation: A 14-year-old girl presented with increasing abdominal distension and intermittent spotting. Examination revealed suprapubic fullness without peritoneal signs and a tense. Laboratory tests were unremarkable except for mild microcytic anemia. Pelvic ultrasonography demonstrated a cystic mass occupying the vagina, and magnetic resonance imaging showed a T1-hyperintense, thin-walled lesion consistent with hemorrhagic content, without uterine or ovarian pathology. Hymenotomy was performed with evacuation of retained blood; postoperative recovery was uneventful. Discussion: This case underscores a clinical pitfall: abdominal mass–like presentation of imperforate hymen in adolescence. Failure to perform a genital examination and overreliance on imaging can result in misdiagnosis and unnecessary oncologic workup. Early recognition prevents complications including hematometra, hematosalpinx, urinary retention, infection, endometriosis, and potential future fertility issues. Ultrasonography is usually diagnostic; MRI refines anatomy and excludes alternative etiologies. Conclusion: In adolescent girls with abdominal distension or an apparent pelvic mass, imperforate hymen should be included in the differential diagnosis. A simple genital examination, supported by ultrasonography and MRI when indicated, enables prompt diagnosis and definitive, low-morbidity surgical management.
Keywords : karın ağrısı, imperfore hymen, akut batın

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