Hematometrocolpos refers to a blood-filled distended uterus and vagina usually due to an anatomical mechanical obstruction precluding the evacuation of the menstrual blood.
The estimated incidence in teenagers is at ~1 in 1000-2000 .
- imperforate hymen: in ~2/3 of cases
- transverse vaginal septum
- vaginal stenosis
- vaginal atresia/hypoplasia
- 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