Abstract
Study Objective
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Accepted:
February 25,
2023
Received in revised form:
February 22,
2023
Received:
August 4,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosure(s): none
Financial Support: none
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of North American Society for Pediatric and Adolescent Gynecology.
