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Unique Presentation of Hematometrocolpos Mimicking Cauda Equina Syndrome: Severe Back Pain and Urinary Incontinence in an Adolescent Girl.
J Emerg Med. 2016 Aug; 51(2):e19-23.JE

Abstract

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.

Authors+Show Affiliations

Pediatric Emergency Department, University Hospital Inselspital, Bern, Switzerland.Department of Pediatric Surgery, University Hospital Inselspital, Bern, Switzerland.Department of Pediatric Surgery, University Hospital Inselspital, Bern, Switzerland.Department of Pediatric Surgery, University Hospital Inselspital, Bern, Switzerland.Department of Pediatric Surgery, University Hospital Inselspital, Bern, Switzerland.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

26924512

Citation

Löllgen, Ruth Mari, et al. "Unique Presentation of Hematometrocolpos Mimicking Cauda Equina Syndrome: Severe Back Pain and Urinary Incontinence in an Adolescent Girl." The Journal of Emergency Medicine, vol. 51, no. 2, 2016, pp. e19-23.
Löllgen RM, Sabo J, Mettler A, et al. Unique Presentation of Hematometrocolpos Mimicking Cauda Equina Syndrome: Severe Back Pain and Urinary Incontinence in an Adolescent Girl. J Emerg Med. 2016;51(2):e19-23.
Löllgen, R. M., Sabo, J., Mettler, A., Liniger, B., & Berger, S. (2016). Unique Presentation of Hematometrocolpos Mimicking Cauda Equina Syndrome: Severe Back Pain and Urinary Incontinence in an Adolescent Girl. The Journal of Emergency Medicine, 51(2), e19-23. https://doi.org/10.1016/j.jemermed.2016.01.031
Löllgen RM, et al. Unique Presentation of Hematometrocolpos Mimicking Cauda Equina Syndrome: Severe Back Pain and Urinary Incontinence in an Adolescent Girl. J Emerg Med. 2016;51(2):e19-23. PubMed PMID: 26924512.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unique Presentation of Hematometrocolpos Mimicking Cauda Equina Syndrome: Severe Back Pain and Urinary Incontinence in an Adolescent Girl. AU - Löllgen,Ruth Mari, AU - Sabo,Jan, AU - Mettler,Anja, AU - Liniger,Benjamin, AU - Berger,Steffen, Y1 - 2016/02/26/ PY - 2015/07/05/received PY - 2015/12/16/revised PY - 2016/01/22/accepted PY - 2016/3/1/entrez PY - 2016/3/1/pubmed PY - 2017/2/25/medline KW - cauda equina syndrome KW - genital examination KW - hematometrocolpos KW - pediatric emergency department SP - e19 EP - 23 JF - The Journal of emergency medicine JO - J Emerg Med VL - 51 IS - 2 N2 - 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. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/26924512/Unique_Presentation_of_Hematometrocolpos_Mimicking_Cauda_Equina_Syndrome:_Severe_Back_Pain_and_Urinary_Incontinence_in_an_Adolescent_Girl_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(16)00043-3 DB - PRIME DP - Unbound Medicine ER -