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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



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.


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

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