Abstract
The rarity and variable presentation of congenital obstruction of the vagina can lead to delayed diagnosis and erroneous management. It is important to be aware of the differential diagnoses and associated anomalies, including the consideration of hydrocolpos (vaginal obstruction) or hydrometrocolpos (indicating uterine involvement), in a female newborn with an abdominal mass and urinary obstruction. A thorough physical genital examination and appropriate imaging can aid in achieving the correct diagnosis. Ultrasonography and magnetic resonance imaging are diagnostic modalities of choice and can reveal associated renal anomalies and the anatomy of complex lesions, although further evaluation may require voiding cystourethrogram. Delayed diagnosis may impair the normal functions of the urogenital system and cause compression of surrounding structures. Interventions range from less complex, such as drainage of imperforate hymen, to more complex reconstructive vaginoplasty through a multidisciplinary team. Early surgical intervention will reduce long-term morbidity.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Okoro PE, Obiorah C, Enyindah CE. Experience with neonatal hydrometrocolpos in the Niger Delta area of Nigeria: upsurge or increased recognition? Afr J Paediatr Surg. 2016;13(4):161–5.
Ameh EA, Mshelbwala PM, Ameh N. Congenital vaginal obstruction in neonates and infants: recognition and management. J Pediatr Adolesc Gynecol. 2011;24(2):74–8.
Tilahun B, Woldegebriel F, Wolde Z, Tadele H. Hydrometrocolpos presenting as a huge abdominal swelling and obstructive uropathy in a 4 day old newborn: a diagnostic challenge. Ethiop J Health Sci. 2016;26(1):89–91.
Khan RA, Ghani I, Wahab J. Hydrometrocolpos due to persistent urogenital sinus mimicking neonatal ascites. Iran J Pediatr. 2008;18(1):67–70.
Romero R, et al. Prenatal diagnosis of congenital anomalies. Norwalk: Appleton and Lange; 1988. p. 307–9.
Messina M, Severi FM, Bocchi C, et al. Voluminous perinatal mass: a case of congenital hydrometrocolpos. J Matern Fetal Neonatal Med. 2004;15:135.
Tseng JJ, et al. Prenatal diagnosis of isolated fetal hydrocolpos secondary to congenital imperforate hymen. J Chin Med Assoc. 2008;71(6):325–8.
Miller RJ, Breech LL. Surgical correction of vaginal anomalies. Clin Obstet Gynecol. 2008;51(2):223–36.
Pena A, et al. Surgical management of cloacal malformations: a review of 339 patients. J Pediatr Surg. 2004;39(3):470–9.
Sadler TW. Langman’s medical embryology. 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2006, Chap. 15. p. 229–56.
DeUgarte CM, et al. Embryology of the urogenital system and congenital anomalies of the female genital tract (Chap. 4). In: DeCherney AH, et al., editors. Current diagnosis and treatment: obstetrics and gynecology. 10th ed. New York: McGraw-Hill; 2007. Available at http://www.accessmedicine.com/content.aspx?aID=2382989.
Schorge JO, et al. Anatomic disorders (Chap. 18). In: William’s gynecology. McGraw-Hill; 2008. Available at http://www.accessmedicine.com/content.aspx?aID=3157418. Surgeries for benign gynecologic conditions (Chap. 41). Available at http://www.accessmedicine.com/content.aspx?aID=3166442.
David A, Bitoun P, Lacombe D, Lambert J, Nivelon A, Vigneron J, et al. Hydrometrocolpos and polydactyly: a common neonatal presentation of Bardet-Biedl and McKusick-Kaufman syndromes. J Med Genet. 1999;36:599–603.
Tekin I, Ok G, Genc A, Tok D. Anaesthetic management in McKusick-Kaufman syndrome. Pediatr Anesth. 2003;13:167–70.
Lueth E, Wood KE. McKusick Kaufman syndrome, complications arising at puberty. J Pediatr Adolesc Gynecol. 2014;27:e125–6.
Kos S, Roth K, Korinth D, Zeilinger G, Eich G. Hydrometrocolpos post axial polydactyly, and hypothalamic hamartoma in a patient with confirmed Pallister-Hall syndrome: a clinical overlap with McKusick-Kaufman syndrome. Pediatr Radiol. 2008;38:902–6.
Shimada K, Hosokawa S, Matsumoto F, Johnun K, Naitoh Y, Harado Y. Urology management of cloacal anomalies. Int J Urol. 2001;81:282–9.
Shono T, Teguchi T, Suita S, Nakanami N, Nekane H. Prenatal ultrasonographic and magnetic resonance imaging findings of congenital cloacal anomalies associated with meconium peritonitis. J Pediatr Surg. 2007;42:681–4.
Laufer MR. Diagnosis and management of congenital anomalies of the vagina. Available at http://www.uptodate.com. Accessed 2008.
Spencer R, Levy DM. Hydrometrocolpos: report of three cases and review of the literature. Ann Surg. 1962;155(4):558–71.
Dhombres F, et al. Contribution of prenatal imaging to the anatomical assessment of fetal hydrocolpos. Ultrasound Obstet Gynecol. 2007;30:101–4.
Hayashi S, et al. Prenatal diagnosis of fetal hydrometrocolpos secondary to cloacal anomaly by magnetic resonance imaging. Ultrasound Obstet Gynecol. 2005;26:577–9.
Valentini AL, et al. Persistent urogenital sinus: diagnostic imaging for clinical management. What does the radiologist need to know? Am J Perinatol. 2016;33:425–32.
Visnjic S, Bastic M, Marcec M, Mesic M. Short-term “double natural orifice catheterization”: non-operative management of hydrocolpos in persistent cloaca patients-case series. J Pediatr Surg. 2018;53:718–21.
Khanna K, Sharma S, Gupta DK. Hydrometrocolpos etiology and management: past beckons the present. Pediatr Surg Int. 2018;34:249–61.
Powell DM, Newman KD, Randolph J. A proposed classification of vaginal anomalies and their surgical correction. J Pediatr Surg. 1995;30(2):271–5.
Rock JA, et al. Pregnancy success following surgical correction of imperforate hymen and complete transverse vaginal septum. Obstet Gynecol. 1982;59:448–52.
Joki-Erkkila MM, Heinonen PK. Presenting and long-term clinical implications and fecundity in females with obstructing vaginal malformations. J Pediatr Adolesc Gynecol. 2003;16:307–12.
El-Messidi A, Fleming NA. Congenital imperforate hymen and its life-threatening consequences in the neonatal period. J Pediatr Adolesc Gynecol. 2006;19(2):99–103.
Cunningham FG, Leveno KJ, Bloom SL, et al. Williams obstetrics. 22nd ed. New York: McGraw-Hill; 2005. p. 685.
Nazir Z, et al. Congenital vaginal obstructions: varied presentation and outcome. Pediatr Surg Int. 2006;22:749–53.
Suggested Reading
Ahment G, et al. Prenatal ultrasonographic features of persistent urogenital sinus with hydrometrocolpos and ascites. Gynecol Obstet. 2008;278:493–6.
Arena F, et al. The neonatal management and surgical correction of urinary hydrometrocolpos caused by a persistent urogenital sinus. BJU Int. 1999;84:1063–8.
Ekenze SO, Ezegwui HU. Hydrometrocolpos from a low vaginal atresia: an uncommon cause of neonatal intestinal and urinary obstruction. Afr J Paediatr Surg. 2008;5(1):43–5.
Khanna K, Sharma S, Gupta DK. Hydrometrocolpos etiology and management: past beckons the present. Pediatr Surg Int. 2018;34:249–61.
Pena A, Levitt M. Surgical management of cloacal malformations. Semin Neonatol. 2003;8:249–57.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Rouma, B.S., Finkelstein, J.B., Aldrink, J.H., Ginsburg, H.B. (2020). Hydrometrocolpos. In: Ameh, E.A., Bickler, S.W., Lakhoo, K., Nwomeh, B.C., Poenaru, D. (eds) Pediatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-41724-6_115
Download citation
DOI: https://doi.org/10.1007/978-3-030-41724-6_115
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-41723-9
Online ISBN: 978-3-030-41724-6
eBook Packages: MedicineMedicine (R0)