Case report endometrial carcinoma presenting as hematometra mimicking a large pelvic cyst mingping wu, md,1,2 chungchieng wu, md,3 fongming chang, md, phd,4 ernest y. Hi, for the above mentioned scenario cpt 57 seems appropriate. Imperforate hymen causing hematocolpos and acute urinary. To document the occurrence of hematocolpos causing sciatica and leg weakness in an adolescent girl. Patients with incomplete longitudinal vaginal septa may present with irregular bleeding and. A related disorder is hematometra, where the uterus fills with menstrual blood. It is sometimes seen in robinow syndrome, uterus didelphys, or. Approximately 1% to 2% of women who undergo operative hysteroscopy. Imperforate hymen presenting with massive hematometra and hematocolpos. Apr, 2020 patients may notice a hematometra in the form of abnormal uterine bleeding or spotting, as well as a feeling of fullness and tenderness in the lower abdomen. The cervix is absent, and the lower uterine segment narrows to terminate in the peritoneal sleeve at a point above the normal communication with the vaginal apex. A case report abstract the hematometra should be suspected in a patient with amenorrhea and recurrent pain in low stomach. Hematometra is an infrequent late complication of operative hysteroscopy.
A haematometrium refers to a uterus filled with blood. Depending upon the amount of blood accumulated, it first distends the vagina hematocolpos. The details of the patients condition were discussed with the patient and her parents, including the complications of outflow obstruction to the right vagina which can lead to hematocolpos, hematometra, hematosalpinx, and later may cause a retrograde bleeding, chronic pelvic pain, endometriosis, and infertility. The medical definition of hematocolpos is an accumulation of blood within the vagina. More than 300 years ago ambroise pare described a case in which, because of amenorrhea, pain and abdominal swelling, the condition was diagnosed as pregnancy. Discussion on ultrasound the uterus and vagina are distended with fluid showing low level echoes with posterior enhancement.
Hematocolpometra definition of hematocolpometra by. The uterus is next involved and the cavity dilated hematometra. A case of massive hematometra with a bicornuate uterus in a 14yearold mentally handicapped girl complicated by vaginal agenesis and absent cervix is presented. Aching in pelvis and low back especially after standing for awhile. Hematocolpos definition of hematocolpos by the free. She did not have any significant medical and surgical history, and her neurological examinations were. It is conditioned by anatomical obstruction of the exit way from menstrual bled, that can release the presentation forms described as hematocolpos, hematometra and he. Presented are two cases of imperforate hymen with hematocolpos seen in a pediatric emergency department ed during a sevenmonth period. Imperforate hymen occurs in approximately 1 in 1,000 females 1, and found incidentally on physical exam 43%, it is treatable and does not cause significant morbidity 2. Patients with complete obstructing longitudinal vaginal septa present with cyclic periods associated with increasingly severe dysmenorrhea fig. Hematometra article about hematometra by the free dictionary. Based on patient age and clinical history, and the classic findings of dilated fluid filled vagina and uterus, the diagnosis was hematometrocolpos due to imperforate hymen. Sailer animperforate hymen isthemostfrequent female genitalanomaly.
It is often caused by the combination of menstruation with an imperforate hymen. She was managed by abdominal hysterectomy and right salpingooophorectomy that included the ovarian cystadenoma. Mri for the diagnosis of uterine anomalies eshre manchester. Hemangioblastoma genetic and rare diseases information. Mar 22, 2016 imperforate hymen is at the extreme of a spectrum of variations in hymenal configuration. Hematocolpos medical definition, flashcards and icd10 codes. Cpt 58558 correctly captures both drainage of hematometrium and multiple polypectomy procedures. Usually is associated with stone impacted in urethra or congenital anomalies. It is often associated with absence of portion or all of the vagina. Low back pain resulting from hematocolpos has been reported previously but not associated with symptoms of sciatica or neurologic weakness. Patients may also report urinary frequency and urinary retention. A gynecologist is usually involved in diagnosis and treatment of this condition.
A case report okafor ii, odugu bu, ugwu ia, oko ds, enyinna pk and onyekpa ij department of obstetrics and gynecology, enugu state university teaching hospital, enugu, nigeria abstract. Evidence based medicine cochrane collaboration on hematocolpos. I have chosen 58999 for the evacuation procedures, 56700 for the hymenectomy and 58180 for the dilation and suction curettage of the uterus in a case of an 11 year old girl with a complete imperforate hymen. A second separate uterus not shown on these images was also present. She reported progressively increasing lower abdominal distension, with pain as well as discomfort over the prior two months, which was. Hi melanie, i would like to ask your coding suggestion for the above procedures.
All types present with hematometra, but only the patients with distal vaginal agenesis or hypoplasia and the obstructed didelphys also have hematocolpos. Hematocolpos is a medical condition in which the vagina is pooled with menstrual blood due to multiple factors leading to the blockage of menstrual blood flow. Eshre pages the thessaloniki eshreesge consensusondiagnosisoffemalegenital anomalies grigoris f. Hematometra definition of hematometra by medical dictionary. It is usually due to obstruction at the level of cervix or uterus. In older women, the obstruction is usually acquired. A diagnosis of hematocolpos secondary to imperforate hymen was made and surgically confirmed. A case of hematocolpos in a 17yrold girl is presented. Common symptoms associated with this disorder include amenorrhea or dysmenorrhea in premenopausal women, pelvic pain or pressure, urinary. Hematometra causes, symptoms, diagnosis and treatment. Hematometra, which developed in the first weeks after birth, is called lohiometra. Gomez arzapalo e, perez mendizabal a, herrera avalos i, et al.
Hematometra is an uncommon disorder that can be caused by congenital or acquired structural obstruction of the cervical canal. Transvaginal ultrasonography of a hematometra after childbirth, seen as a hypoechoic darker area within the uterine cavity. A hemangioblastoma is a benign, highly vascular tumor that can occur in the brain, spinal cord, and retina the lightsensitive tissue that lines the back of the eye. Hematocolpos definition of hematocolpos by medical. Hematometra causas, sintomas, diagnostico e tratamento. Retained secretions andmenstrual blood maydistend thevagina anduterus toproduce hematocolpos and hematometra resulting inanabdominal mass. Vaginal examination usually reveals a paravaginal mass, and pelvic ultrasound shows hematometra and hematocolpos on the obstructed side fig. We report in this case, 10 years old child presented with acute urinary retention. Hematometra and hematotrachelos are a rare condition, which means retention of blood in uterine cavity and cervix, respectively. With careful ultrasound examination associated severe complications such as hematometra andor hematosalpinx can be ruled out preoperatively. Hematocolpos the reader wiki, reader view of wikipedia. Hematometra pode estar associado a ambos os patologia orgao anomalias congenitas e doencas adquiridas do utero e vagina, e razoes funcionais hemostasia inadequada e ma contracao do miometrio. The uterine wall is thicker than the vaginal wall and the vagina appears more distended. Imperforate hymen causing hematocolpos and acute urinary retention in a 14yearold adolescent we report the case of a 14yearold girl who visited the emergency room because of suprapubic discomfort and sudden acute urinary retention.
Hematometra and hematocolpos, secondary to cervical canal. Malformations of the female generative organs hematocolpos. The first case presented with abdominal pain, urinary obstruction, and constipation on initial visit. Feb 18, 2011 hematometra is an accumulation of blood within the uterus. The hematocolpos associated with uterus didelphys can be differentiated from hematocolpos due to an imperforate hymen, by demonstration of the level of the obstruction. Mr of the female pelvis diger mulleryen sistem anomalileri. The ultrasound findings are described and discussed.
Articles on hematocolpos in n eng j med, lancet, bmj. A rare case of hematometra and hematotrachelos springerlink. Hematocolpos definition of hematocolpos by the free dictionary. Hematometra typically presents as cyclic, cramping pain in the midline of the pelvis or lower abdomen. Hematometra develops when the uterus becomes distended with blood secondary to obstruction or atresia of the lower reproductive tractthe uterus, cervix or vaginawhich would otherwise provide an outflow for menstrual blood. Massive hematometra due to congenital cervicovaginal agenesis. The syndrome known as imperforate hymen with hematocolpos has been recognized for centuries and yet is seldom diagnosed by the physician who first sees the patient. Premenopausal women with hematometra often experience abnormal vaginal bleeding, including dysmenorrhea pain during menstruation or amenorrhea lack of menstruation, while postmenopausal women are more. If there is a backup of blood or fluid in the vagina, this may extend into the uterine cavity and result in an associated hematometra. On the axial t2weighted image, the fluid collections in the vagina posterior to the bladder have varied signal, indicating subacute and more recent hemorrhage. Le guide des sorties et loisirs en famille partout en france pour les vacances.
Hematometra is a condition involving collection or retention of blood or blood clots inside the uterus pic. The code is valid for the year 2020 for the submission of hipaacovered transactions. Hematocervix, una nueva variedad marcelino hernandez. Obstruction within the distal vagina is usually responsible for the development of a hematocolpos.
Hematocolpos definition of hematocolpos by medical dictionary. The upper potion of the vagina was also dilated and filled with blood hematocolpos, and ended blindly owing to the presence of a vaginal atresia. In the late and neglected stages, the tubes may also be distended after the fimbrial ends become. A 17yearold nulligravida female presented to a regional emergency department for evaluation of leftlowerquadrant bulging and pain. It is sometimes seen in robinow syndrome, uterus didelphys, or other vaginal anomalies. Hematometra, otherwise known as hemometra is a condition in which blood is collected and retained in the uterus, commonly the result of an imperforate hymen or transverse vaginal septum the physical obstruction of menstrual blood from the uterus causes a significant back up of menstrual blood over time, which can cause the uterus to enlarge, putting pressure on other pelvic organs, similar. The cervix is located to the left in the image, and the fundus is located to the right. Imperforate hymen presenting with massive hematometra and. It may be, rarely, seen as a post surgical complication as in our case. We report a case of recurrent hematometra and hematocolpos due to cervical agenesis. This may lead to hematocolpos, hematometra, and hematosalpinx.
On the axial t1weighted image, two hyperintense structures, which represent a double vagina, are seen posterior to the bladder. Hematocolpos hematometra pdf imperforate hymen presenting with massive hematometra and hematocolpos. Return back by esc key or x button in the right bottom corner. This video shows hematocolpos with hematometra or hemometra. It may also be found in elderly women with cervical stenosis. Recurrent hematometra and hematocolpos due to cervical. Preoperative ultrasound diagnosis of hematocolpos sciencedirect. Thus, the underlying etiology of the obstruction in this patient was uncertain, and this case denotes an unusual cause of acquired spontaneous hematometra and hematocolpos developed following progestin use. Hematometra, also known as hemometra or post abortion syndrome, is a medical term which describes an accumulation of blood clots in the uterus and affects the fertility of women. Considering cervical defect as acquired disease, you can code this as 622. Hematocolpos medical definition merriamwebster medical. Custom fabricated acrylic vaginal stent as an adjunct.
Pdf hematometra and hematocolpos, secondary to cervical. This treatment was considered appropriate for this patient. Hematometra or hemometra is a medical condition where collection or retention of blood is seen in the uterus. Recurrent hematometra and hematocolpos due to cervical agenesis. Most often, this complication arises because of the uterine atony postpartum, the cause of which may become a weak labor activity, hyperextension of the uterus large fruit, manual removal of placenta, hemorrhagic shock, scars on the uterus and others. If cyclic or chronic lower pelvic pain occurs after surgery in menstruating women or among women taking hormone replacement therapy, scarring or narrowing of the endometrial cavity may be the cause. When there is concurrent uterine distention, the term hematometrocolpos is used. Evaluation of anterior cervical defect with a hysteroscope would be considered as diagnostic hysteroscopy and would get bundled with 58558. Hematometra is usually seen in adolescent females with imperforate hymen or with a transverse vaginal septum. Variations in the embryologic development of the hymen are common and result in fenestrations, septa, bands, microperforations, anterior displacement, and differences in rigidity andor elasticity of the hymenal tissue. May 23, 2019 hematocolpos hematometra pdf imperforate hymen presenting with massive hematometra and hematocolpos. Hematometra and hematocolpos, secondary to cervical.
Examination under anesthesia bundled procedure and cant be reported revealed a bulging vaginal outlet. One potential cause of hematometra is hematosalpinx, where bleeding occurs in the fallopian tube. Drainage of hematometrium obgyn coding ask an expert. Ultrasound video showing hematocolpos with hematometra or. Hematocolpos secondary to imperforate hymen article pdf available in international journal of emergency medicine 34. It can be caused by a series of medical problems or diseases, and the treatment consists in. We report a case of recurrent hematometra and hematocolpos due to.
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