Neonatal imperforate hymen with hydrocolpos.

To cite: Ramphul M, Perry L, Bhatia C. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016215434 DESCRIPTION A 34+4 weeks neonate was born by spontaneous vaginal delivery with normal antenatal scans. Routine neonatal examination revealed the absence of a vaginal opening with bulging of vaginal introitus (figure 1). Urethral and anal openings were patent. A provisional diagnosis of an imperforate hymen with hydrocolpos was considered. Subsequent investigations revealed a deranged renal function at 22 hours of life (creatinine 99 mmol/L, urea 10.2 mmol/L, K 6.6 mmol/L and Na 132 mmol/L). An urgent abdominal ultrasound was arranged to rule out hydronephrosis. The kidneys and lower genitourinary tract were normal. The imperforate hymen was managed surgically through a hymenal incision. Subsequently, the external female genitalia appeared normal (figure 2) and the renal function normalised. A positive family history was noted with an elder sibling who also had an imperforate hymen, which was surgically treated at 5 months. The incidence of imperforate hymen is estimated at 0.014–0.1% and presentation is often late with amenorrhea in adolescence. Hydrocolpos is cystic dilation of the vagina with fluid accumulation due to stimulation of secretory glands of the reproductive tract secondary to vaginal obstruction. Hydrocolpos may lead to obstructive uropathy through the compression of the lower urinary tract, resulting in hydronephrosis and hydroureters. Hence early detection is essential as it could be associated with life-threatening renal failure. As observed in our report, cases of familial recurrence have been reported. A thorough newborn examination is essential to screen for an imperforate hymen, which can result in renal complications in the neonatal period.