Hematometrocolpos

Hematometrocolpos refers to a blood-filled distended uterus and vagina usually due to an anatomical mechanical obstruction precluding the evacuation of the menstrual blood.

Epidemiology

The estimated incidence in teenagers is at ~1 in 1000-2000 .

Pathology

Causes

• imperforate hymen: in ~2/3 of cases
• transverse vaginal septum
• vaginal stenosis
• vaginal atresia/hypoplasia

Associations

• Mullerian duct anomalies: uterus didelphys
• anal, renal, cardiac and vertebral anomalies

Radiographic features

Ultrasound

• may show a distended midline cystic structure between the bladder and the rectum 
• internal echotexture can be variable; often low-level echoes may be seen
• associated hydrosalpinx may be seen
• associated Mullerian malformations such as Mullerian agenesis, obstructing vaginal septum, unicornuate uterus, bicornuate uterus, uterus didelphys and septate uterus should be looked for 
• examination of the kidneys should be performed to screen for obvious associated urological tract malformation, commonly associated with Mullerian malformations

Treatment and prognosis

If large enough it can cause:

• obstruction of regional lymph drainage
• obstructive hydronephrosis

See also

• haematometrium
• hydrocolpos
• hydrometrocolpos