Trait profile of maize varieties preferred by farmers and value chain actors in northern Ghana.

Plant breeders' knowledge of precise traits preferred by variety users would accelerate varietal turnover and widen adoption of newly developed maize varieties in Ghana. The objective of this research was to provide empirical evidence of trait preferences of farmers and other actors in the maize value chain in northern Ghana, based on which research strategies for maize improvement could be formulated. Participatory rural appraisal was conducted in 2016 to determine key traits preferred by maize value chain actors across the three regions in northern Ghana. A total of 279 maize value chain actors were interviewed. Different scoring and ranking techniques were used to assess the maize traits preferred by the different actors. Participatory variety selection trials were also conducted in the Tolon, West Gonja, Binduri, and Sissala East districts in northern Ghana from 2014 to 2016. The mother-baby trial approach was used to evaluate eight hybrids with 3000 farmers. Data on yield and agronomic performance of the hybrids and farmer's selection criteria were collected. Data analyses were performed using GenStat Edition 16 and SPSS Edition 20 statistical packages. The participatory rural appraisal method identified farmers, input dealers, traders, and processors as the primary maize value chain actors in the study areas. Trait preferences of the different actors overlapped and revolved around grain quality including nutritional value, and stress tolerance and grain yield. Results of the participatory variety selection study revealed that across districts, farmers preferred high-yielding varieties with multiple cobs per plant, white grain endosperm color, and bigger and fully filled cobs. For the first time, our holistic assessment of the trait preferences of key actors of the maize value chain in northern Ghana revealed a comprehensive list of traits, which could be used by breeders to develop varieties that may be preferred by all value chain actors in northern Ghana. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13593-021-00708-w.

Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Ghana.

BACKGROUND/PURPOSE: Perioperative complications cause significant pediatric morbidity and mortality in low- and lower middle -income countries. This study investigates factors associated with prolonged length of stay, 90-day readmission and in-hospital mortality among pediatric patients at Eastern Regional Hospital (ERH) in Ghana. METHODS: This is a retrospective review of perioperative morbidity and mortality in children < 18 years at ERH in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study. Univariate analysis was performed using Pearson's chi-square tests or Fisher's exact tests. Variables that were significant on univariate analysis were included in multivariable logistic regression models adjusted for age and gender. RESULTS: We analyzed 468 patients < 18 years of age with a median length of stay (LOS) of 3 days. The 90-day readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19 %) and appendectomy (15 %). Gastrointestinal surgery, surgical trauma, surgical infection and lack of insurance were significantly associated with prolonged LOS. Young age and female gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission. CONCLUSIONS: Malaria infection is a significant risk factor for readmission, which should be investigated and treated in pediatric surgical patients in rural Ghana. Ensuring that all patients have insurance may result in shorter hospital stays. Provision of laparoscopic equipment may reduce hospital stays for patients undergoing gastrointestinal surgery. Expansion of the surgical work force, particularly pediatric surgeons, could improve perioperative survival in the very young population. LEVEL OF EVIDENCE: Retrospective comparative study.

Pyramiding aphid resistance genes into the elite cowpea variety, Zaayura, using marker-assisted backcrossing.

The cowpea aphid (Aphis cracivora) is a cosmopolitan insect pest that causes economic damage on cowpea. Although the pest persists at all the growth stages of the crop, in West Africa, aphids are the only major insect pests that farmers regularly control at the vegetative stage. Thus, deploying aphid-resistant crop varieties can reduce farmers' expenditure on insecticide. The availability of different biotypes of the pest and reports of resistance breakdown necessitates pyramiding of sources of aphid resistance to develop a more robust genotype for durable resistance. Two aphid-resistance genes, sourced from SARC-1-57-2 and IT97K-556-6, were introgressed through gene pyramiding technique into a farmers' preferred cowpea variety, Zaayura, using marker-assisted backcrossing. A simple sequence repeat (SSR) marker, CP 171F/172R, and an allele-specific single nucleotide polymorphism (SNP) marker, 1_0912, were used for foreground selection of the SARC-1-57-2 and IT97K-556-6 aphid resistance genes, respectively. A stepwise backcross approach was used to introgress the major aphid resistance QTL (QAc-vu7.1) from IT97K-556-6 into Zaayura using the marker 1_0912 coupled with intermittent screening under artificial aphid infestation. After the fourth backcross generation, three heterozygous BC4F1 of Zaayura/TT97K-556-6 were intercrossed to Zaayura Pali to develop intercross F1 (ICF1). Three true ICF1 hybrids allowed to self to produce ICF2. Five (5) out of 48 ICF2 plants which were genotyped with the two foreground markers had the two aphid resistance genes fixed in the double homozygous dominant state. For background selection, out of 192 allele-specific markers screened, only 47 polymorphic markers were identified and used for the background analysis of the pyramided lines. The recurrent parent genome recovery ranged from 72 to 93.8 %. ICF2_Zaa/556/SARC-P6 had the highest recurrent parent genome and the least heterozygosity among the five improved lines. The five pyramided lines showed superior resistance under artificial aphid infestation as compared to the two donor parents with damage scores ranging from 2.0 to 2.3. On the field, however, there were no significant differences between the pyramided lines and their recurrent parent for all the agronomic traits measured except for grain yield. The pyramided lines do not only stand the chance of being released as new varieties but are also valuable genetic resources for other breeding programs that seek to improve cowpea for aphid resistance.

Genotype by Phytophthora colocasiae isolate interaction in breeding for resistance to taro [Colocasia esculenta var esculenta (L.) Schott] leaf blight disease in Ghana.

Two experiments were undertaken to evaluate the resistance of 5 parents and 20 hybrids of dasheen taro (n = 25) developed through the diallel method to Phytophthora leaf blight disease which is also known as taro leaf blight disease (TLBD). The field experiment which was laid out in Randomized Complete Block Design with 3 replications assessed the disease incidence (%) and disease severity index (DSI%) among the genotypes planted in three (3) agro-ecological zones in Ghana. In the laboratory the parents and hybrids were inoculated with three (3) Phytophthora colocasiae isolates from Dormaa Ahenekro, Tano Dumasi and Bunso in the Bono, Ashanti and Eastern regions of Ghana respectively and the diameter of lesions formed on the leaves after five days of inoculation were measured. Significant differences (p < 0.05) among the parents and hybrids for resistance to the Phytophthora colocasiae isolates, TLBD incidence (%) and DSI (%) in the field were observed making room for selection for further breeding for resistant varieties of dasheen taro. The isolate effect and genotype by isolate interaction effect were not significant (p > 0.05) indicating the similarity of the isolates' virulence and pathogenicity and therefore any of the isolates identified can be used to screen for resistance to TLBD in Ghana. Hybrids BL/SM/115 × BL/SM/10, BL/SM/115 × CE/MAL/32, CE/MAL/32 × BL/SM/10, CE/MAL/32 × CE/IND/16 and CE/IND/16 × BL/SM/115 and parent CE/IND/16 were observed to have no disease incidence with corresponding zero DSI (%) making them highly resistant and therefore can further be field evaluated and be recommended to farmers for cultivation. The highly significant and positive predictive value for TLBD incidence and DSI (%) based on the lesion area on leaf discs suggests that resistant genotypes of TLBD can be selected at the laboratory without spending long periods of time and money for evaluating genotypes in the field.

Evaluation and phenotypic plasticity of taro [Colocasia esculenta (l.) Schott.] genotypes for nutrient and anti-nutrient composition.

The study was carried out to determine the nutritional and anti-nutritional composition of taro genotypes and also determine the phenotypic plasticity of the genotypes in two agro ecological zones in Ghana. The towns and zones were Bunso in the semi deciduous forest (an upland) and Tano Dumasi in the forest savannah transition agro-ecological (a waterlogged area) zone in the Eastern and Ashanti regions respectively.Two (2) freshly harvested corms of each genotype from each location were assessed for their nutritional (moisture, protein, carbohydrate, ash and fat) and anti-nutritional (phytate, oxalate and tannin) composition Data collected were subjected to analysis of variance and AMMI analysis using GenStat 12 edition to assess the effect of genotype, environment and their interaction on the traits studied. Phenotypic plasticity for the genotypes and the traits studied was also calculated. Pearson correlation was also conducted to assess the relationship between the traits studied. There were significant differences among the genotypes for nutrient and anti-nutrient composition except for percentage fat, indicating enough genetic variability among the genotypes, giving room for good selection progress for development of taro varieties. A higher magnitude of the environment over genotype and genotype by environment interaction observed indicates the influence of environment in the expression of the nutritional and anti-nutritional traits. Observed varied phenotypic plasticity among the genotypes for the nutrient and anti-nutrients composition also indicates varied adaptation of the genotypes to the environment. Genotypes BL/SM/115, CE/MAL/32 and CE/IND/16 and hybrids KAO19 × CE/MAL/32 and CE/IND/16×KAO19, CE/IND/16 × BL/SM/10, and CE/IND/16 × BL/SM/115 which recorded high nutrients and low anti-nutrients content and were stable across the environments can be released to farmers for cultivation. They could also be included in breeding programs for the development of enhanced nutritional quality of taro in Ghana.

Combining Abilities and Heterotic Patterns among Early Maturing Maize Inbred Lines under Optimal and Striga-Infested Environments.

Information on the general combining ability of inbred lines and the specific combining ability of hybrid combinations is crucial for successful hybrid development. The objectives of this study were to (i) determine the combining ability of thirty selected early maturing maize inbred lines under Striga-infested and optimal environments, (ii) classify the inbred lines into heterotic groups using the general combining ability effects of multiple traits (HGCAMT) and the single nucleotide polymorphism genetic distance (SNP- GD) methods, and (iii) assess the effectiveness of the heterotic grouping methods. One hundred and fifty single-cross hybrids were generated from the thirty inbred lines using the North Carolina Design II mating method. The hybrids and six local check varieties were tested across optimal and Striga-infested environments in Ghana and Nigeria in 2016 and 2017. The inheritance of grain yield was controlled by the non-additive gene action under both environments and the additive gene action across the two research environments. The non-additive gene action modulated the inheritance of measured traits under Striga-infested environments, except for the Striga damage syndrome rating at 8 weeks after planting. Maternal effects were observed for most traits in each environment and across environments. The inbred lines TZEI 127 and TZEI 40 exhibited significant and positive GCA male and female effects for grain yield under each environment and across the two research environments, indicating the presence of favorable alleles for yield improvements. The SNP-GD heterotic grouping method was identified as the most adequate in grouping the thirty inbred lines.

Genetic control of earliness in cowpea (Vigna unguiculata (L) Walp).

Global climate change is expected to further intensify the already harsh conditions in the dry savannah ecological zones of sub-Saharan Africa, posing serious threats to food and income security of millions of smallholder farmers. Breeding cowpea for improved earliness could help minimize this risk, by ensuring that the crops complete their lifecycle before the cessation of rainfall. In this study, we crossed two sets of cowpea lines showing contrasting phenotypes for earliness in terms of days to 50% flowering (DFF). One set of the lines comprised three extra-early parents (viz.: Sanzi-Nya, Tobonaa and CB27, 30-35 DFF), and the other set consisted of three early-to-medium maturity lines (viz.: Kirkhouse-Benga, Wang-Kae and Padi-Tuya, 42-45 DFF). The derived crosses and their parents were evaluated for key earliness-related traits at Nyankpala and Manga sites of CSIR-Savanna Agricultural Research Institute (SARI), Ghana. To unravel the genetic control of measured traits, we compared the appropriateness of Chi-square goodness of fit tests using classical Mendelian ratios, and frequency distribution (histogram)-related statistics such as skewness and kurtosis. The Chi-square test suggested a single dominant gene mode of inheritance for earliness, whereas the quantitative methods implicated duplicate epistasis and complementary epistatic gene actions. Our results show that coercing segregating lines to fit into classical Mendelian ratios to determine the genetic control of earliness could be misleading, due to its subjectivity. Thus, the genetic control of earliness in cowpea is governed by complementary and duplicate epistasis. The most applicable breeding approach for traits influenced by duplicate epitasis is selection of desirable recombinants from segregating populations developed from bi-parental crosses. Complementary epitasis, as found in the Wang-Kae × CB27 cross, could be exploited in developing improved extra-early lines through backcrossing. Heritability and genetic advance estimates were high for days to first flower appearance (DFFA) and days to 95 % pod maturity (DNPM) in the Padi-Tuya × CB27 and Kirkhouse-Benga x CB27 crosses, indicating that breeding for extra-earliness is feasible. CB27 could be a good donor for introgression of earliness into medium to late maturing improved cowpea varieties, because crosses developed from it had high heritability and genetic advance estimates.

Heat Stress Tolerance: A Prerequisite for the Selection of Drought- and Low Phosphorus-Tolerant Common Beans for Equatorial Tropical Regions Such as Ghana.

Forty common bean accessions of multiple genetic background trait attribution regarding drought tolerance were selected based on mean yield performance from an earlier field test evaluation conducted using augmented RCBD. The various bean genotypes were further evaluated with phosphorus and water treatment interactions at two different levels for each factor. The experiment was conducted in a 2 × 2 × 40 factorial using RCBD with three replications under screen-house conditions at the CSIR-Crops Research Institute, Kumasi-Ghana. The objective was to select drought- and low phosphorus-tolerant common bean genotypes; which are suitable for tropical climatic conditions. The results showed that common bean with drought and heat trait tolerance survived, developed flowers and podded with seeds to physiological maturity, whilst genotypes with no heat trait tolerance had impaired reproductive structural development and growth disruption; thus, flowers could not develop into pods with seeds. This reproductive developmental anomaly was due to prevailing average daytime and nighttime high temperatures of 35.45 °C and 29.95 °C, respectively, recorded during the growth period, which reduced pollen fertility. Among the 478 experimental bean plants (two plants were missing) analyzed, 141 (29.5%) did not flower, 168 (35.18%) had their pods dropped whilst 99 (20.7%) podded with seeds to achieve physiological maturity. The podded-seed bean genotypes were of the SEF-line pedigrees, which were shown to be heat and drought-tolerant. Meanwhile, bean accessions with SMC, SMN and SMR code prefixes did not pod into seed despite possessing drought-tolerant traits. The effects of interactions between phosphorus and water treatments on the root characteristics of drought-tolerant common bean were as follows: root length, root surface area, average root diameter and root volume growth extensions doubled dimensionally under optimum conditions (P2W2) compared to stressed conditions (P1W1). The results from the present study identified four SEF-bean genotypes, namely, SEF15, SEF 47, SEF 60 and SEF 62, as superior yield performers, even under low soil phosphorus and in extreme high temperature conditions. Therefore, breeding for the selection of drought- and low-P-tolerant common bean for tropical agro-ecological environments must also consider concomitant heat stress tolerance.

Burden of cancer in the general surgical population in the eastern region of Ghana.

OBJECTIVE: To estimate the surgical burden of malignant disease in the Eastern Region of Ghana. DESIGN: Descriptive cross-sectional study. SETTING: Regional hospital in the eastern region of Ghana. PARTICIPANTS: Patients treated by the surgery department at Eastern Regional Hospital in Koforidua, Ghana. INTERVENTIONS: None. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was incidence of malignancy and secondary outcome descriptive differences between patients who had a benign indication for surgery compared with those with a malignant indication for surgery. RESULTS: A total of 1943 inpatient surgical procedures were performed from 2015 to 2017 with 13.4% (261) of all procedures ultimately performed for malignancy. Of all breast procedures performed, 95.2% of procedures resulted in a malignant diagnosis. The remaining subtypes of procedures had rates ranging from <1% to 41.2% of procedures performed for malignant disease. Additionally, this study found over 13% of patients admitted to the surgical service for breast cancer ultimately did not undergo a surgical procedure. CONCLUSION: This is the first study investigating the burden of malignant disease in the Eastern Region of Ghana. We found a substantial prevalence of malignant disease in the surgical population in this region. This information can be used to aid in future medical resource planning in this region.

High-density DArT-based SilicoDArT and SNP markers for genetic diversity and population structure studies in cassava (Manihot esculenta Crantz).

Cassava (Manihot esculenta Crantz) is an important industrial and staple crop due to its high starch content, low input requirement, and resilience which makes it an ideal crop for sustainable agricultural systems and marginal lands in the tropics. However, the lack of genomic information on local genetic resources has impeded efficient conservation and improvement of the crop and the exploration of its full agronomic and breeding potential. This work was carried out to obtain information on population structure and extent of genetic variability among some local landraces conserved at the Plant Genetic Resources Research Institute, Ghana and exotic cassava accessions with Diversity Array Technology based SilicoDArT and SNP markers to infer how the relatedness in the genetic materials can be used to enhance germplasm curation and future breeding efforts. A total of 10521 SilicoDArT and 10808 SNP markers were used with varying polymorphic information content (PIC) values. The average PIC was 0.36 and 0.28 for the SilicoDArT and SNPs respectively. Population structure and average linkage hierarchical clustering based on SNPs revealed two distinct subpopulations and a large number of admixtures. Both DArT platforms identified 22 landraces as potential duplicates based on Gower's genetic dissimilarity. The expected heterozygosity which defines the genetic variation within each subpopulation was 0.008 for subpop1 which were mainly landraces and 0.391 for subpop2 indicating the homogeneous and admixture nature of the two subpopulations. Further analysis upon removal of the duplicates increased the expected heterozygosity of subpop1 from 0.008 to 0.357. A mantel test indicated strong interdependence (r = 0.970; P < 0.001) between SilicoDArT and DArTSeq SNP genotypic data suggesting both marker platforms as a robust system for genomic studies in cassava. These findings provide important information for efficient ex-situ conservation of cassava, future heterosis breeding, and marker-assisted selection (MAS) to enhance cassava improvement.

Mapping chromosomal regions associated with anther indehiscence with exerted stigmas in CRI-48 and Jasmine 85 cross of rice (Oryza sativa L).

Anther indehiscence in certain wide crosses combines male sterility with stigma exertion, a phenomenon that is desirable for hybrid rice seed production. This study sought to identify chromosomal region(s) that combine anther indehiscence with exerted stigmas. A mapping population consisting of 189 BC1F1 plants was derived from a cross between CRI-48 and Jasmine 85 and backcrossing the resulting F1 to Jasmine 85. Contrary to the three complementary genes mode of inheritance reported earlier, a single locus (AI6-1) was mapped on chromosome 6 at 27.4 cM for anther indehiscence with exerted stigmas through a mixed model-based composite interval mapping (MCIM). This locus was flanked by two single nucleotide polymorphism (SNP) markers, K_ID6002884 and K_ID6003341 within a range of 23.1-28.9 cM. The allele at the locus was contributed by the CRI-48 parent which has Oryza glaberrima ancestry. This locus is suggested to control anther indehiscence and stigma exertion through pleiotropic gene action or cluster of genes.

Identifying heterotic groups and testers for hybrid development in early maturing yellow maize (Zea mays) for sub-Saharan Africa.

Identification of heterotic groups and efficient testers, which are important prerequisites for the development of outstanding hybrids, has been a major challenge to its success, especially for early and extra-early germplasm. This study was carried out to (a) identify the most efficient heterotic grouping method for classifying a set of inbred lines and (b) determine the efficiency of testers in classifying inbred lines into heterotic groups. A total of 205 hybrids obtained by crossing 41 inbred lines with five standard testers were evaluated together with five hybrid checks under drought, low soil nitrogen (N), Striga-infested and optimal environments in Nigeria between 2014 and 2016. The heterotic group's specific and general combining ability (HSGCA) method was more effective in classifying the inbred lines into heterotic groups. Testers TZEI 17 and TZEI 23 were the most efficient across environments and could be invaluable for classifying other lines into heterotic groups and assessing combining ability of maize inbreds. In addition, these testers and heterotic groups represent an invaluable resource for development of outstanding hybrids in sub-Saharan Africa (SSA).

Epidemiology and Perioperative Mortality of Exploratory Laparotomy in Rural Ghana.

Background: Perioperative mortality rate (POMR) has been identified as an important measure of access to safe surgical and anesthesia care in global surgery. There has been limited study on this measure in rural Ghana. In order to identify areas for future quality improvement efforts, we aimed to assess the epidemiology of exploratory laparotomy and to investigate POMR as a benchmark quality measure. Methods: Surgical records were reviewed at a regional referral hospital in Eastern Region, Ghana to identify cases of exploratory laparotomy from July 2017 through June 2018. Patient demographics, health information, and outcomes data were collected. Logistic regression was used to identify predictors of perioperative mortality. Findings: The study included operations for 286 adult and 60 pediatric patients. Only 60% of patients were covered by National Health Insurance (NHI). The overall POMR was 11.5% (12.6% adults; 6.7% pediatric). Sixty percent of mortalities were referrals from outside hospitals and the mortality rate for referrals was 13.5%. Odds of mortality was 13 times greater with perforated peptic ulcer disease (OR = 13.1, p = 0.025) and 12 times greater with trauma (OR = 11.7, p = 0.042) when compared to the most common operation. Female sex (OR = 0.3, p = 0.016) and NHI (OR = 0.4, p = 0.031) were protective variables. Individuals 60 years and older (OR = 3.3, p = 0.016) had higher mortality. Conclusion: POMR can be an important outcome and quality indicator for rural populations. Interventions aimed at decreasing emergent hernia repair, preventing perforation of peptic ulcer disease, improving rural infrastructure for response to major trauma, and increasing NHI coverage may improve POMR in rural Ghana.

Testcross performance and combining ability of early maturing maize inbreds under multiple-stress environments.

Availability of multiple-stress tolerant maize is critical for improvement in maize production in West and Central Africa (WCA). A study was carried out to (i) assess a set of inbred lines for combining ability under stressed and optimal conditions, (ii) determine the performance of the testcrosses under different conditions, and (iii) identify outstanding hybrids across the conditions. Two hundred and five testcrosses were planted with five hybrid checks under Striga-infested, low soil nitrogen, drought and optimal conditions between 2015 and 2016 in Nigeria. The grain yield inheritance under optimal condition was largely regulated by additive gene effect whereas non-additive gene effects largely regulated grain yield under the three stresses. Four of the inbreds had significant positive general combining ability effects each under low N and drought, and three under Striga infestation for grain yield. The inbreds could be vital sources of beneficial alleles for development and improvement of tropical yellow maize hybrids and populations. Hybrids TZEI 443 x ENT 13 and TZEI 462 x TZEI 10 were high yielding and stable; they out-performed the three early maturing released hybrids in WCA. The new hybrids should be extensively assessed and released in the sub-region to improve food security.

Genetic diversity and population structure of early-maturing tropical maize inbred lines using SNP markers.

Information on genetic diversity and population structure are very important in any breeding programme for the improvement of traits of interest and the development of outstanding products for commercialization. In the present study, we assessed the genetic diversity of 94 early-maturing white and yellow tropical maize inbred lines using single nucleotide polymorphism (SNP) markers. The larger number of SNP markers used in this study allowed a clearer inference of the population structure of the 94 inbred lines. Cluster analysis resolved the inbred lines into different clusters based on their pedigree, selection history and endosperm colour. However, three heterotic groups were revealed by population structure analysis, but additional field evaluation could be more informative to confirm the heterotic groups identified. Nevertheless, wide genetic variability existed among the inbred lines making them unique with the potential to contribute new beneficial alleles to maize breeding programmes in the tropics, especially in the West and Central Africa (WCA) sub-region.

Imperforate hymen and leaking hematosalpinx mimicking acute appendicitis: A report of a rare case and a review of literature.

INTRODUCTION: Cases of imperforate hymen with leaking hematosalpinx into the peritoneum are rare. We present a case of imperforate hymen mimicking acute appendicitis creating diagnostic challenges with a near miss diagnosis. CASE: A 12-year-old premenarchal female presented with severe pain that migrated from the epigastrium to the right lower quadrant. Physical examination revealed an ill-defined non-tender mass in the right lower quadrant on deep palpation, without signs of peritonitis. We made a diagnosis of an appendiceal mass and the patient underwent an appendectomy. We found approximately 200 mL of dark blood in the peritoneum and an inflamed appendix. After the appendectomy we noticed an engorged right fallopian tube leaking into the peritoneum and a bulky pelvic mass in the lower segment of the uterus. Perineal examination revealed a slightly bulging imperforate hymen. Hymenectomy was performed and 500 mL of viscous old blood was drained. On follow-up, the hymen was still open. DISCUSSION: Imperforate hymen commonly presents with cyclic abdominal pain and enlarging mass in premenarchal females, it is rare to present with hemoperitoneum and mimicking acute appendicitis. CONCLUSION: Although rare, imperforate hymen with retrograde menstruation that causes dilatation of the vagina and uterus (i.e., hematocolpometra) is an important consideration in the differential diagnosis of abdominal pain in premenarchal females with abdominal pain. It is easily diagnosed by physical examination. However, if patient or parents refuse genital exam evaluation, imaging studies can greatly help with diagnosis. Ultrasound will show an echogenic fluid accumulation in the vagina that can extend to uterus.