HYDROMETROCOLPOS

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.