Pyocolpos — a rare cause of neonatal sepsis

A newborn female infant presented with a lower abdominal mass and sepsis. Radiologic and ultrasonic studies established the diagnosis of pyocolpos. Surgical drainage was successfully carried out. Hydrocolpos is an uncommon anomaly resulting from imperforate hymen or atresia of the vagina. It usually presents in the first few weeks of life as an asymptomatic abdominal mass or with symptoms due to compression of adjacent structures by the enlarged vagina. Rarely, pyocolpos results from an infected hydrocolpos, usually associated with vaginal atresia rather than imperforate hymen. It may cause life-threatening sepsis; early diagnosis and prompt surgical drainage are therefore essential. The infant described demonstrates the diagnostic approach and the management of pyocolpos. Offprint requests to: O. Zamir     

Delayed Diagnosis of Herlyn-Werner-Wunderlich Syndrome due to Microperforation and Pyocolpos in Obstructed Vaginal Canal

BackgroundTo present a rare anomaly consisting of uterus didelphys, longitudinal vaginal septum, obstructed hemivagina with pyocolpos, fistula to the open vaginal canal, and ipsilateral renal agenesis, referred as Herlyn-Werner-Wunderlich syndrome (HWWS).CaseA 14-year-old girl with recurring purulent vaginal discharge lasting for a few months. Preoperative examination revealed one vaginal canal with one cervical opening on the right side. There was a fistula leading from the obstructed vaginal canal to the left vagina. Intravaginal ultrasound examination demonstrated a longitudinal vaginal septum and a closed pyocolpos on the right side. The longitudinal vaginal septum was excised by way of electrocauterization under direct vision.ConclusionHWWS should be considered in the differential diagnosis in patients with uterus didelphys and unusual symptoms such as pyocolpos and vaginal discharge.     

Microperforate Hymen and Pyocolpos: A Case Report and Review of the Literature

Background

Microperforate hymen is a rare congenital anomaly characterized by a small pinpoint opening in the hymen; girls with this anomaly are prone to develop ascending pelvic infections and recurrent urinary tract infections.

High vaginal atresia: surgical considerations

During the past 15 years, six patients have been treated for high vaginal atresia in the Surgical Unit of the Department of Pediatrics, University Medical School of Pécs, Hungary. In three of the patients distal atresia of the vagina was found (type III); two of the three were neonates and had a large hydrometrocolpos and the third, a 13-year-old girl, had a hematometrocolpos. In the fourth patient the vaginal atresia was associated with a cloacal and anorectal malformation (type V). In the fifth there was a duplication of uterus and vagina; however, only one of the two vaginas was atretic. In the sixth patient the vaginal occlusion was not congenital but acquired. In three patients a pull-through of the vagina was carried out; in one the procedure according to Pena and in another a transvesical approach according to Monfort was used. In the patient with a cloacal malformation, the vagina was replaced by large intestine in several stages. In the patient with duplication of the vagina and uterus one-half of the duplication was removed. The acquired occlusion was treated by the abdominoperineal approach.Presented at the 59th Annual Meeting of the Surgical Section of the American Academy of Pediatrics, Boston MA, 6–8 October 1990 Correspondence to: A. B. Pintér     

Pyocolpos: A rare cause of recurrent abdominal pain - Always insist on a thorough physical examination

Thorough physical examination is a must for proper diagnosis of medical diseases and to elucidate all physical findings. Abdominal pain is a very common presentation to Emergency Department, compromising 5%-10% of all visits, and around a quarter are discharged with no particular diagnosis. Pyocolpos is one of those presentations that requires a thorough physical examination, including that of the external genitalia. A 3-year-old girl presented with recurrent history of abdominal pain and a recent history of fever with acute abdomen picture-like presentation, with difficulty voiding over the past few days. She was previously assessed for recurrent abdominal pain, without any identifiable etiology. Upon inspection for indwelling catheter insertion, absence of the vaginal introitus was noted with a bulging mass and an imperforate hymen. Pyocolpos was diagnosed and drained following hymenotomy. Pyocolpos is a rare complication of hydrocolpos. Enlarged vagina causes extrinsic compression to nearby structures, such as the bladder trigone and ureters, causing hydronephrosis, hydroureter, and other sequel including acute kidney injury and urosepsis. An imperforate hymen must be considered in the differential for chronic and recurrent abdominal pain, and can be easily identified by a thorough physical examination, including that of the external genitalia, which is a must in today''s every medical practice.     

An unusual diagnosis of a bicornuate unicollis uterus

We present a case of an unusual diagnosis of a bicornuate unicollis uterus mimicking a uterus didelphys with blind hemivagina. Few cases of a bicornuate uterus have been reported with the primary symptom of a paracervical pyocolpos. The difficulties involved in the diagnosis and management of this particular congenital malformation are described in detail. The role of imaging techniques and adequate preoperative preparation is emphasised with a review of recent literature.