Open Access Case report

Hematometra presenting as an acute abdomen in a 13-year-old postmenarchal girl: a case report

Peter Klimek1, Miriam Klimek2, Ulf Kessler1*, Valerie Oesch3, Rainer Wolf5, Enno Stranzinger5, Michael D Mueller4 and Zacharias Zachariou1

Author Affiliations

1 Department of Pediatric Surgery, Inselspital, University of Berne, Berne, Switzerland

2 Department of Obstetrics and Gynecology, Regionalspital Emmental, Burgdorf, Switzerland

3 Department of Pediatric Surgery, Kantonsspital Aarau, Aarau, Switzerland

4 Department of Obstetrics and Gynecology, Inselspital, University of Berne, Berne, Switzerland

5 Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Berne, Berne, Switzerland

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Journal of Medical Case Reports 2012, 6:419  doi:10.1186/1752-1947-6-419

Published: 12 December 2012

Abstract

Introduction

Most underlying diseases for abdominal pain in children are not dangerous. However some require rapid diagnosis and treatment, such as acute ovarian torsion or appendicitis. Since reaching a diagnosis can be difficult, and delayed treatment of potentially dangerous diseases might have significant consequences, exploratory laparoscopy is a diagnostic and therapeutic option for patients who have unclear and potentially hazardous abdominal diseases. Here we describe a case where the anomaly could not be identified using a laparoscopy in an adolescent girl with acute abdomen.

Case presentation

A 13-year old postmenarchal caucasian female presented with an acute abdomen. Emergency sonography could not exclude ovarian torsion. Accurate diagnosis and treatment were achieved only after an initial laparoscopy followed by a laparotomy and after a magnetic resonance imaging scan a further laparotomy. The underlying disease was hematometra of the right uterine horn in a uterus didelphys in conjunction with an imperforate right cervix.

Conclusion

This report demonstrates that the usual approach for patients with acute abdominal pain may not be sufficient in emergency situations.

Keywords:
Adolescent; Acute abdomen; Genital malformation; Hematometra; Uterus didelphys