A case of image-guided hematometrocolpos drainage requiring tissue plasminogen activator in a pediatric patient

• Type of Material: Article
• Authors: Pareena Sharma, Emory University; Jay Shah, Emory University; Nancy Sokkary, Emory University
• Language: English
• Date: 2024-02
• Publisher: Oxford University Press
• Publication Version: Final Published Version
• Copyright Statement: Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): https://doi.org/10.1093%2Fjscr%2Frjae006
• Title of Journal or Parent Work: Journal of Surgical Case Reports
• Volume: 2024
• Issue: 2
• Start Page: rjae006
• Grant/Funding Information: None declared.
• Keywords: percutaneous drainage; hematometrocolpos; hematocolpos; tissue plasminogen activator; interventional radiology
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Radiology

Abstract

Hematometrocolpos (HMC) is a rare disorder that occurs when an anatomical anomaly like imperforate hymen causes menstrual blood to be retained in the uterus and vagina. There is no standard of care established for HMC beyond urgent vaginoplasty which requires a demanding post-operative course that may not be suited for all pediatric patients. This is a case report of successful use of image-guided percutaneous drainage of HMC with tissue plasminogen activator (TPA) followed by vaginoplasty in a 13-year-old female with lower vaginal atresia. Additionally, this case explores the role of menstrual suppression and the need for individualized guidelines. It emphasizes the potential of image-guided percutaneous drainage with TPA as a promising, less-invasive treatment option for pediatric HMC as well as the impact on follow-up surgery.