Pediatric emergency medicine trisk 2163 2163

normal pubertal development without expected menarche. As the hematocolpos
grows, it can interfere with urination, causing urgency, frequency, or dysuria. An
abdominal ultrasound can aid in the diagnosis of hematocolpos. Although the
differential diagnosis for a patient with amenorrhea and a lower abdominal mass
on physical examination includes pregnancy or tumors, the characteristic
appearance of the introitus covered by a bluish bulging membrane is diagnostic of
hematocolpos with imperforate hymen. Patients with a high transverse vaginal
septum will be more difficult to diagnose because the introitus will appear
normal. However, palpation of the vagina will demonstrate obstruction, and the
cervix will not be palpable.
The emergency physician should also consider the diagnosis of congenital
vaginal obstruction in patients with acute urinary retention. Due to chronic
intrinsic pressure, patients can have variable degrees of hydroureter or
hydronephrosis; rarely, infants will present with respiratory insufficiency or
inferior vena cava obstruction because of the large mass. While imperforate
hymen is usually an isolated anomaly, other types of obstruction, chiefly
transverse vaginal septum, are regularly associated with renal malformations,
including hypoplastic or single kidneys, and duplicated or ectopic collecting
systems; presence of additional anomalies should be considered when this
condition is diagnosed.
Patients with congenital vaginal obstruction need surgical treatment;
hymenotomy for an imperforate hymen and excision for a transverse vaginal
septum. Surgery should be planned urgently for adolescents but can be performed
electively for asymptomatic infants and children.

LABIAL ADHESIONS
CLINICAL PEARLS AND PITFALLS
Labial adhesions are a common, usually asymptomatic disorder of
childhood.
Treatment is not necessary in asymptomatic cases.
Manual separation of adhesions should be avoided.

Labial adhesions are a common disorder of childhood, occurring in
approximately 0.6% to 3% of prepubertal girls. Labial adhesions are thought to be
an acquired disorder classically thought to occur due to a lack of estrogen
combined with irritation, often due to poor hygiene, diaper rash, vaginitis, and