title: Concomitant imperforate hymen and transverse vaginal septum complicated with pyocolpos and abdominovaginal fistula.
abstract: A 13-year-old patient with a complaint of worsening lower abdominal pain during the past 4 months was admitted to the emergency department. An abdominopelvic ultrasound scan revealed a distended uterocervical cavity suggestive of hematometrocolpos. Imperforate hymen was observed on examination of the external genitalia. MRI scan revealed an air-fluid level representing pyometrocolpos within a distended vagina. Posterior vaginal extraperitoneal leakage as the sign of a fistula between the vagina and the rectovaginal space was detected. Although laparoscopic approach was planned, malodorous pus expelled after the insertion of the Veress needle, it was decided to proceed to laparotomy. Pus with peritoneal microabscess formations was observed at laparotomy. The imperforate hymen and TVS were excised vaginally. A more complex anomaly should be suspected in cases with hematometra and concomitant imperforated hymen without any bulging and thorough evaluation using radiological imaging techniques should be performed before surgical approach.
authors.affiliation: Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Berna
authors.initials: B
authors.lastname: Dilbaz
authors.affiliation: Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Sadiman
authors.initials: S
authors.lastname: Kiykac Altinbas
authors.affiliation: Department of Radiology, Diskapi Children's Hospital and Hematology Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: Namik Kemal
authors.initials: NK
authors.lastname: Altinbas
authors.affiliation: Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Sengul
authors.affiliation: Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Dilbaz