HYDROMETROCOLPOS
Category: Pediatric Surgery
Abstract : Hydrometrocolpos (HMC) is accumulation of secretions in the vagina and uterus
caused by one of two mechanisms: 1- excessive intrauterine stimulation of the
infant's cervical mucous glands by maternal estrogen (secretory HMC),
or 2- accumulation of urine (urinary HMC)in the presence of a vaginal
obstruction. HMC can arise from congenital or acquired pathology.
Acquired ca
Hydrometrocolpos (HMC) is accumulation of secretions in the vagina and uterus
caused by one of two mechanisms:
1- excessive intrauterine stimulation of the
infant's cervical mucous glands by maternal estrogen (secretory HMC),
or
2- accumulation of urine (urinary HMC)in the presence of a vaginal
obstruction.
HMC can arise from congenital or acquired pathology.
Acquired causes include vaginitis from Diphtheria or measles, senile vaginitis,
from radiation therapy and corrosive vaginitis. Congenital vaginal obstruction
causing HMC is due to imperforate hymen, transverse vaginal septum and
persistence of urogenital sinus with complete distal vaginal obstruction. The
child may present with a lower abdominal mass from the dilated vagina and
uterus, urogenital sinus, obstructive uropathy (hydronephrosis), dribbling,
respiratory distress, bowel obstruction and lower extremity venous congestion.
HMC usually occurs in the neonatal period and the majority of cases are caused
by vaginal occlusion by a transverse septum combined with cervical secretion.
HMC can be associated with congenital adrenal hyperplasia when there is a long
urogenital sinus.
Physical exam (obvious vagina septum of imperforate
hymen or a urogenital sinus), US (large cystic anechoic mass, anteriorly
compress bladder and fluid-debris level), voiding cystogram, and sinoscopy can
establish the cause of HMC.
Vaginal decompression by catheter placement,
endoscopic septotomy or vaginostomy is done initially followed later by opening
of septum or vaginal pull-through.
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