To describe cases of image-guided drainage of symptomatic hematometrocolpos from obstructive Mullerian anomalies as a temporizing measure to manage acute pain symptoms and delay definitive management of the obstructive Mullerian anomalies which require complex reconstruction.
IRB exemption from all included institutions was obtained. A retrospective case series of eight females from three academic children's hospitals under the age of 21 with symptomatic hematometrocolpos due to obstructive Mullerian anomalies drained by image-guided percutaneous transabdominal vaginal or uterine drainage with interventional radiology were reviewed and described.
Eight pubertal patients with obstructive Müllerian anomalies (six patients with distal vaginal agenesis, one patient with an obstructed uterine horn, one patient with a high obstructed hemi-vagina) and symptomatic hematometrocolpos are reported. All patients with distal vaginal agenesis had greater than 3 cm lower vaginal agenesis, which would usually require complex vaginoplasty and use of post-operative stents. Given immaturity and inability to use stents or dilators post-operatively or medical complexity, they subsequently underwent ultrasound-guided drainage of hematometrocolpos with interventional radiology (IR) to relieve pain symptoms, followed by menstrual suppression. The patients with obstructed uterine horns had complex medical and surgical histories requiring perioperative planning, also had ultrasound-guided drainage of hematometra as a temporizing measure to manage acute symptoms.
Patients presenting with symptomatic hematometrocolpos due to obstructive Müllerian anomalies may not be psychologically mature enough to undergo definitive complex reconstruction which requires vaginal stent or dilator use post-operatively to prevent stenosis and other complications. Image-guided percutaneous drainage of symptomatic hematometrocolpos serves as a temporizing measure by offering pain relief until patients are ready to undergo surgical management and/or allow time for complex surgical planning.
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Accepted: February 25, 2023
Received in revised form: February 22, 2023
Received: August 4, 2022
Publication stageIn Press Journal Pre-Proof
Financial Support: none
© 2023 Published by Elsevier Inc. on behalf of North American Society for Pediatric and Adolescent Gynecology.