Congenital imperforate hymen.

To cite: Laghzaoui O. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016215124 DESCRIPTION A 16-year-old girl was referred to our gynaecology service, reporting of cyclic pelvic pain and primary amenorrhoea. The medical history had begun 4 years earlier with pelvic pain getting worse over time, disturbing her studies. Physical examination revealed a mass of 14 weeks’ gravid uterus. The patient’s secondary sexual characters were well developed (breasts, pubic and underarm hair). Examination of the vulva revealed an imperforate hymen. Digital examination of the rectum perceived a tense and compressible pelvic mass. The patient weighed 55 kg and was 165 cm tall, her blood pressure was 100/ 50 mm Hg and rate 76 bpm, her temperature was normal, 37°C. Transabdominal ultrasonography and MRI confirmed the diagnosis: the imperforate hymen was 3 cm thick, haematocolpos measured 12×9.5 cm and haematometra was noted (figure 1). This malformation was classified as U0.C0.V3 according to the European Society of Human Reproduction and Embryology classification of congenital malformations. We opted for a large excision of the hymen— because the membrane’s thickness measured 3 cm —and a plasty using the vaginal tissue to prevent hymen restenosis (figure 2). Figure 1 Interference reflection microscopy (IRM)— imperforate hymen.