A case of Herlyn-Werner-Wunderlich syndrome with exacerbation of hematometra after adnexectomy.

A 27-year-old nulliparous woman presented with a feeling of fullness in the lower abdomen and abdominal pain. A left ovarian tumor, uterus didelphys, left renal agenesis, and left vaginal atresia were observed on imaging. The ovarian tumor was presumed to have caused the abdominal pain, and an abdominal left adnexectomy was performed. After 3 months, she reported severe lower abdominal pain during menstruation. Transvaginal ultrasonography revealed uterine enlargement. After 17 days, the patient presented with abdominal pain and fever. She was diagnosed with peritonitis due to infection and left uterine hematometra. Because she did not improve with antibiotic treatment, left laparoscopic hysterectomy was performed. Subsequently, she did not experience the lower abdominal pain. Appropriate diagnosis and treatment based on the morphology of the reproductive tract and symptoms must be considered in patients with Herlyn-Werner-Wunderlich syndrome. Treatment must permit the outflow of menstrual blood.

Hematometra y hematocervix en paciente postmenopáusica: reporte de caso / Hematometry and hematocervix in postmenopausal patient: case repor

El hematometra es la retención de sangre en el útero y comúnmente se presenta en mujeres jóvenes con anomalías mullerianas pero puede aparecer también en mujeres postmenopausicas por causas secundarias como traumas, tumores, terapia de remplazo hormonal, estenosis cervical, entre otras. En esta presentación de caso interesante se describe una mujer postmenopáusica bajo terapia de remplazo hormonal. Dicha mujer inicia con hemorragia uterina anormal por lo que se le realiza ultrasonido evidenciando hematómetra y hematocervix. Como método diagnóstico y terapéutico de la hemorragia postmenopáusica se le realiza histerectomía abdominal en la cual la patología evidencia leiomiomatosis uterina con endometrio secretor

Hematometra is the retention of blood in the uterus and commonly occurs in young women with Mullerian abnormalities but can also appear in postmenopausal women due to secondary causes such as trauma, tumors, hormone replacement therapy, cervical stenosis, among others. In this presentation an interesting case is described a postmenopausal woman under hormone replacement therapy. She said woman began with abnormal uterine bleeding, so an ultrasound was performed showing hematometer and hematocervix. As a method diagnosis and treatment of postmenopausal hemorrhage, abdominal hysterectomy is performed in which the pathology shows uterine leiomyomatosis with secretory endometrium

Diagnosis and Surgical Treatment of Uterine Isthmus Atresia: A Case Report and Review of the Literature.

Uterine isthmus atresia is a rare Müllerian duct anomaly occasionally diagnosed in adolescents with primary amenorrhea and cyclic abdominal pain. A case is presented of a 14-year-old female with monthly cyclic lower abdominal pain of a 2-year duration. Magnetic resonance imaging and 3-dimensional ultrasound showed separation of a 10-mm fibrotic tissue between the cervical canal and the endometrial cavity. In an attempt to preserve reproductive ability, an end-to-end anastomosis was laparoscopically performed between the cervical canal and uterine cavity. A platinol stent (WallFlex Biliary RX; Boston Scientific, Boston, MA) was placed by hysteroscopy to avoid stenosis after surgery. Laparoscopic end-to-end anastomosis is proposed to treat congenital uterine isthmus atresia.

Cause or Coincidence? Spontaneous Hematometra in Young Women Receiving Depomedroxyprogesterone Acetate: A Small Case Series.

BACKGROUND: Abdominal pain, secondary amenorrhea, and abnormal uterine bleeding are common gynecologic presentations in adolescence. Rarely this can be associated with an acquired hematometra. Hematometra is a condition of retained blood or clot within the uterus. High-dose progestogenic agents in this age group have been implicated in the accumulation of a hematometra without other explanation. CASES: We present 4 cases of hematometra after depomedroxyprogesterone acetate (DMPA) therapy in previously menstruating adolescents. All 4 presented with abdominal pelvic pain and/or persistent abnormal uterine bleeding, with the diagnosis confirmed via ultrasound. Suction dilation and curettage was required in each case. SUMMARY AND CONCLUSION: DMPA is a possible cause of hematometra and should be considered in anatomically normal young women experiencing pain or abnormal bleeding out of character for typical long-term DMPA use.

Acute abdominal pain caused by hematometra in an adolescent female: a case report.

BACKGROUND: Hematometra is a pathologic collection of blood in the uterus. It is a rare condition that is most commonly associated with congenital anomalies or prior surgical procedures causing an obstruction of the genitourinary outflow tract. We present an unusual case of hematometra in a healthy and active adolescent female with no prior risk factors. This is a rare and important case report due to the complexity of diagnosis when a young female presents with an acute abdomen. In addition, for a patient who presents with no prior risk factors for hematometra, such as in our patient, the diagnosis and workup may become overly complicated, adding strain to patient care and health care cost. To the best of our knowledge and based on an extensive literature search, there has not been a reported case of hematometra in an adolescent female without any aforementioned risk factors. CASE PRESENTATION: Our patient is a healthy 18 year-old white woman with no significant prior medical or surgical history. Her only medication was depot medroxyprogesterone acetate use for contraception. She presented to a local emergency department with acute abdominal pain, accompanied by emesis and nausea. Workup with ultrasonography showed uterine distention most likely caused by hematometra, although no obvious cause was noted. She was treated with dilation and curettage; she was also advised to discontinue depot medroxyprogesterone acetate use. She was symptom free without recurrence of hematometra at 6-month follow-up. CONCLUSIONS: Due to the high prevalence of abdominal pain, this case report has a wide breadth of implications for health care providers ranging from general family practitioners to emergency room physicians and obstetricians/gynecologists. This case report provides potential future advancement in management and differential diagnosis in adolescent females presenting with acute abdominal pain. In addition, the use of depot medroxyprogesterone acetate contributing to or causing hematometra cannot be ruled out in our patient and warrants further investigation.

Unique Presentation of Hematometrocolpos Mimicking Cauda Equina Syndrome: Severe Back Pain and Urinary Incontinence in an Adolescent Girl.

BACKGROUND: Imperforate hymen with hematometrocolpos in adolescent females is a rare pediatric condition. Classical presentation includes abdominal pain or a pelvic mass in female patients with primary amenorrhea. Atypical complaints and reluctance among emergency physicians to perform genital examination in the emergency department or the pediatric emergency department (PED) may delay correct diagnosis. CASE REPORT: We report a unique, cauda equina syndrome-like presentation of hematometrocolpos secondary to imperforate hymen in a 13-year old, previously healthy girl with primary amenorrhea. In the PED, the unusual clinical presentation of severe back pain and urinary incontinence initially mimicked cauda equina syndrome and led to delayed correct diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The novelty of this case is a cauda equina-like presentation of imperforate hymen secondary to hematocolpos. This report illustrates the highly variable clinical presentation of this rare gynecological pediatric entity. It underlines the importance of considering this rare condition in the differential diagnosis of severe upper or lower back pain alongside voiding abnormalities including urinary retention and incontinence in adolescent females with primary amenorrhea. Above all, the importance of performing a thorough history and genital examination in this subgroup early in the investigation process in the PED emerges from this case. Essentially, excellent clinical judgment and genital examination by the emergency physician may minimize unnecessary radiological investigations and ultimately, accelerate correct diagnosis and expedite appropriate surgical treatment. However, not only pediatric and adult emergency physicians, but also pediatricians and general practitioners should be aware of this entity and its diverse clinical presentation.

A postconization hematometra revealed a rare case of endocervical bone metaplasia.

BACKGROUND: Hematometra is an unusual occurrence in young women undergoing conization; moreover, osseous metaplasia of the uterine cervix is a very rare event, with 7 cases in the literature. A postconization hematometra due to endocervical ossification is a unique occurrence. The authors report such an event. CASE: A young woman undergoing conization developed progressive hypoamenorrhea with pelvic pain. Pregnancy test was negative and a transvaginal ultrasound showed an image of suspected hematometra. Diagnostic hysteroscopy showed an endocervical obstruction due to a bone formation of the uterine cervix, which was removed with an office operative hysteroscopy. After surgery, the patient restored normal menstrual cycle. Histological examination revealed a cervical bone metaplasia. CONCLUSIONS: In premenopausal women undergoing conization, the appearance of a progressive hypoamenorrhea with pelvic pain could suggest a cervical mechanical obstruction that could be an uncommon stenosis. Despite this case represents a very rare event, a postconization hematometra due to an endocervical ossification can be managed with an office operative hysteroscopy.

[Hematocervix, a new variety of hematometra. A case report]. / Hematocervix, una nueva variedad del hematómetra. Reporte de caso.

The hematometra should be suspected in a patient with amenorrhea and recurrent pain in low stomach. It is conditioned by anatomical obstruction of the exit way from menstrual bled, that can release the presentation forms described as hematocolpos, hematometra and hematosalpinx. Report does not exist where alone the cervix is affected, for what the case is described with connotation of hematocervix. Patient of 32 years, regular menstruation, begins symptoms 25 days later to the menstruation, characterized by intense abdominal pain, for what goes to the service of gineco-obstetrics urgencies, where it is hospitalized under diagnose of abdominal painful syndrome. The transvaginal sonographic reports long cervix and with distention for a collection liquidates, the intern cervical hole open, the external minimally dehiscent, scarce flow of the contained endocervical toward the vaginal way through the external hole, for its ecographic aspect compatible with hematic material. The diameters anteroposterior and transverse of the cervix of 2.50 and 4.57 cm respectively. Was passed to surgical room, CEH with fibrosis that hindered the open dilation, for what were take both lips of the cervix and proceeded to dilation with Hegar until number 6, begin glide of dark and dense blood approximately in 60 mi. The evolution was good, since later to the anesthetic event, she referred remission of the pain and the sonographic control demonstrated cervix of normal anatomical characteristic, inclusive until year of follow. A wide diversity of symptoms and clinical data have been demonstrated that should have present for the hematometra diagnosis, among those that are the urinary retention, tennesmus and presence of painful pelvic mass, but the recurrent abdominal pain is the constant in all the cases.

Imperforate hymen presenting as chronic low back pain.

Imperforate hymen in an adolescent usually presents with cyclic abdominal pain or with pelvic mass associated with primary amenorrhea. We present a 13-year-old girl with chronic lower back pain of 6 months' duration as the only complaint. On physical examination, multiple trigger points were detected in the quadratus lumborum and gluteus medius muscles bilaterally. Abdominal ultrasound revealed hematometrocolpos secondary to an imperforate hymen. Hymenectomy was performed, with complete resolution of the back pain. Myofascial pain syndrome with a viscerosomatic reflex is a possible explanation for the clinical presentation of our patient.

[Uterine fibroids complicated by haematometra]. / Hematometra als complicatie bij uterus myomatosus.

BACKGROUND: Uterine fibroids are common, benign tumours of the myometrium. The clinical symptoms include menorrhagia, abdominal pain and subfertility. CASE DESCRIPTION: A 37-year-old black woman known to have uterine fibroids presented at the gynaecology outpatient clinic with abdominal pain. Ultrasonography and an MRI scan revealed haematometra caused by an obstructive myoma, which was drained during a hysteroscopy. The patient was subsequently treated with gonadotrophin-releasing hormone (GnRH) agonist in order to reduce the myoma. Resection of the myoma will take place sometime in the future. CONCLUSION: Haematometra is an accumulation of blood in the uterine cavity. It is a rare complication of uterine fibroids and causes abdominal pain and enlargement of the uterus. Amenorrhoea is often a finding because an adequate outflow of menstrual blood is no longer possible. The primary treatment is to drain the haematometra; a subsequent myomectomy should be performed.

Giant cell tumor of uterus resembling osseous giant cell tumor: case report and review of literature.

Osteoclast-like giant cells (OLGCs) are multinucleated cells of histiocytic lineage and have been identified in a wide array of neoplasms. In the uterus, they have most frequently been reported in association with leiomyosarcomas. This article describes a case of an osteoclast-like giant cell-rich uterine tumor that was essentially indistinguishable at the morphologic and immunophenotypic levels, from typical giant cell tumor of bone. This is the first example of such a case that has been reported in the uterus to the authors' knowledge.

Útero unicorne con cuerno rudimentario no comunicante en la adolescencia / Unicornuate uterus with noncommunicating rudimentary horn in adolescence

El útero unicorne es una rara malformación uterina que resulta del desarrollo anormal de uno de los conductos de Müller. Se manifiesta habitualmente con dismenorrea, dispareunia y dolor pélvico que aparece pocos meses después de la menarquia, aunque existen casos de presentación tardía o asintomática. Los médicos deben tener en cuenta la importancia de esta rara anomalía congénita del aparato genital femenino, especialmente poco después de la menarquia porque sin un diagnóstico y tratamiento precoz, las pacientes pueden desarrollar endometriosis, infertilidad, y complicaciones graves. Presentamos el caso de una paciente de 15 años con dolor pélvico crónico originado por un útero unicorne con un cuerno rudimentario no comunicante (AU)

Unicornuate uterus is a rare uterine anomaly resulting from the abnormal development of one of the Müllerian ducts. This abnormality usually manifests with dysmenorrhea, dyspareunia and pelvic pain appearing a few months after menarche, although there are late or even asymptomatic presentations. Clinicians should be aware of the importance of this rare congenital anomaly of the female genital tract, especially when symptoms occur shortly after menarche, because without early diagnosis and treatment, patients carrying this anomaly may develop endometriosis, infertility, and severe complications. We report the case of a 15-year-old girl with chronic pelvic pain caused by a unicornuate uterus with a noncommunicating rudimentary horn (AU)

An unusual case of hematometra in a postmenopausal woman associated with Manchester repair.

BACKGROUND: Hematometra is a rare condition caused by obstruction of the lower female genital tract resulting in an accumulation of menstrual fluid in the uterine cavity. Although most commonly a result of congenital abnormalities, in older women, the obstruction is usually acquired and occurs at the level of the cervix.The Manchester repair procedure, done for uterocervical prolapse as an alternative to vaginal hysterectomy, carries a risk of cervical scarring resulting in stenosis and hematometra. CASE REPORT: A 61-year-old woman presenting with acute pelvic pain on a background of chronic pelvic pain and urinary retention was found to have a pelvic mass. She underwent magnetic resonance imaging, and her case was discussed in the gynecologic oncology multidisciplinary meeting. She underwent a midline laparotomy and was found to have hematometra. This was a result of the post-Manchester repair amenorrhea being considered as menopause, leading to a gradually accumulating hematometra. CONCLUSIONS: Very few Manchester repairs are being carried out these days. Although advocated as a safe alternative to vaginal hysterectomy, clinicians doing this procedure should be aware of long-term complications like cervical stenosis.

MRI of the female pelvis: a possible pitfall in the differentiation of haemorrhagic vs. fatty lesions using fat saturated sequences with inversion recovery.

The use of fat-saturated techniques should be an integral part of the work-up of any T1-hyperintense structure in the female pelvis for tissue characterization and for differentiation of a fat-containing ovarian mature teratoma from a haemorrhagic lesion. Two cases with haematocolpos and haematometra are presented, respectively. The haemorrhagic content showed high signal both on T1- and T2-weighted images, whereas an unexpected signal decrease in the fat-saturated T2-weighted inversion-recovery sequence was encountered. This unspecific suppression of signal in tissues with similar T1 relaxation times as fat can lead to a diagnostic pitfall both in T1- and T2-weighted STIR pulse sequences. Furthermore, a loss of signal on T2-weighting may also be due to the phenomenon of "T2-shading" in T1-bright ovarian endometrioma. Therefore, the fat-specific spectral fat-saturation of T1-weighted images is strongly recommended for tissue characterization in gynaecological disease.