title: Unique Case of Imperforate Hymen.
abstract: BACKGROUND
  Imperforate hymen typically presents in adolescence with pain, hematocolpometra and primary amenorrhea. This case documents a previously unreported etiology for an atypical presentation with a history of recent menstruation.
  
  
  METHODS
  A female adolescent presented with symptoms of urinary retention and leg pain. She reported a history of irregular, painful menses. Clinical examination revealed a pelvic mass and imperforate hymen. Sonography was consistent with hematocolpometra. Before a planned hymenectomy, the patient began to pass dark blood through a fistulous opening in her vulva. Hymenectomy resulted in complete resolution of the pain and hematocolpometra.
  
  
  CONCLUSIONS
  Identification of the fistulous tract explained the patient's history of menstrual bleeding despite an imperforate hymen. Spontaneous rupture of hematocolpometra through a fistulous tract to the vulva is a previously unreported atypical presentation of imperforate hymen in a "menstruating" adolescent with pain and a pelvic mass.
authors.affiliation: Baptist Medical Centre, Nalerigu, Ghana. Electronic address: lcoppola@obgyn.arizona.edu.
authors.forename: Lynn
authors.initials: L
authors.lastname: Coppola
mesh_terms: D000293:Adolescent; D000568:Amenorrhea / Q000209:etiology; D000013:Congenital Abnormalities; D004412:Dysmenorrhea / Q000209:etiology; D005260:Female; D005402:Fistula / Q000209:etiology; D006409:Hematometra / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D006924:Hymen / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D007866:Leg; D008599:Menstruation Disturbances / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D059352:Musculoskeletal Pain / Q000209:etiology; D016896:Treatment Outcome; D014463:Ultrasonography; D016055:Urinary Retention / Q000209:etiology; D014623:Vaginal Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D014845:Vulvar Diseases / Q000209:etiology
keywords: Adolescent; Amenorrhea; Hematocolpometra; Imperforate hymen