Publication:

Pyocolpos at puberty: a very rare entity

This is a case report of a 12 year girl who reported with a H/O incomplete bladder evacuation & burning in micturition since one month, urinary incontinence once only. She had no abdominal pain or fever & had not attained menarche. The stature was short, thelarche attained 4 months back. No bulge in abdomen. Other general examination features normal. Urine examination was normal. USG suggested hematocolpos with imperforate hymen. On this basis local examination was done. Imperforate hymen with otherwise normal external genitalia found. Pubic & axillary hair absent. Preoperative diagnosis was imperforate hymen & hematocolpos with ? androgen insensitivity syndrome. She could not afford serum DHEAS levels. With this diagnosis it was worrisome to think that patient had attained menarche (cryptomenorrhoea) with androgen insensitivity as pubic & axillary hair had not appeared even after the presumed menarche, which should have appeared well before menarche. Her short stature was also not expected to change after menarche. Hymenotomy under GA done, 490 ml of mucopurulent discharge was drained. Postoperative period uneventful. Now she is expected to have a growthspurt, adrenarche & menarche. In prepubertal girls with urinary complains, the possibility of imperforate hymen with hematocolpos/pyocolpos should be considered as differential diagnosis. Incorporating an examination of external genitalia into routine practice of clinicians caring for children can prevent the significant delay in the diagnosis of imperforate hymen.