Hydrocolpos

Key points

Differentials:

1. Imperforate hymen

2. Vaginal atresia

3. OHVIRA (Obstructed hemivaginal ipsilateral renal agenesis - Herlyn Werner Wunderlich)

4. Transverse vaginal septum

Ensure pain is well controlled, patient resuscitated as necessary

History

Menstrual cycle

Examination

Secondary sexual characeristics

Abdomen and perineum with chaperone for bulging hymen

USS + MRI - looking at uterus and renal tract

Management

Joint with gynaecology

Imperforate hymen - cruciate incision

OHVIRA - resection of vaginal septum

Atresia - Perineal incision + pullthrough - anastomosis - interposition graft with colon etc may be needed

Transverse vaginal septum - complete resection of septum + anastomosis - interposition graft with colon etc may be needed

Vaginostomy to temporise if needed

References

Tanitame, K., Tanitame, N., Urayama, S. et al. Congenital anomalies causing hemato/hydrocolpos: imaging findings, treatments, and outcomes. Jpn J Radiol 39, 733–740 (2021). https://doi.org/10.1007/s11604-021-01115-7