HEMATOMETROCOLPOS

1. Definisi
Accumulation blood and endometrial tissue accumulates and distends the vaginal canal
(hematocolpos), uterus (hematometra), or both (hematometrocolpos) akibat
imperforate hymen
2. Epidemiology
one in 2,000 females
3. Etiology
 failure of the endoderm of the urogenital sinus and the epithelium of the vaginal
vestibule to fuse and perforate during embryonic development
 It is thought that the hymen normally perforates during the perinatal period at
approximately 22 weeks.
 Specific etiologies for the failure to establish patency are not evident. The cause
may be related to failure of apoptosis due to a genetically transmitted signal, or
it may be related to an inappropriate hormonal milieu. Familial inheritance in
successive generations has been described
4. Pat-Pat
 It is important to have a good grasp of embryology of the hymen to understand
its nature and common anomalies that may ensue. Although the sex of the
developing embryo is determined at the time of fertilization, external genitalia
are the same till the 7th week of embryological development.
 The genital ducts develop from two pairs of ducts; mullerian and wollfian ducts
(Fig 2). The mullerian duct arises as a longitudinal invagination of the epithelium
on the anterolateral surface of the urogenital ridge.
 Cranially, the duct opens into the abdominal cavity. Caudally, it passes lateral to
wollfian duct, then crosses it ventrally to grow caudomedially in close contact
with the opposite duct. The two adjacent parts of the ducts fuse together
forming the uterine canal.
 The caudal tip of this canal forms a bulge into the posterior wall of urogenital
sinus, forming mullerian tubercle.
 The fate of these ducts depends upon the genetic sex of the embryo. In XX
individuals, the mullerian ducts develop into a uterus, fallopian tubes and
vagina.
 Vagina develops from two sources; the caudal part of uterine canal as well as
solid vaginal plate, proliferating from the sinovaginal bulbs at the tip of fused
mullerian ducts.
  Later, central canalization of the vaginal plate occurs, leaving the peripheral
cells that form the epithelium of the vagina. Until late in the female's fetal life,
the lumen of the vagina is separated from the cavity of the urogenital sinus by
the hymen (Fig 3).
 During the perinatal period, it ruptures and remains as a thin fold of mucous
membrane just within the vaginal orifice.

Anatomic variations of the patent hymen exist, with the most common being an
annular or circumferential hymen in which the hymen completely surrounds the
vaginal orifice and has a central opening. Other appearances of the hymen
include crescentic, fimbriated, septate, cribriform, and microperforate forms. In
some patients, perforations do not become confluent, and a cribriform pattern
with multiple small perforations may be observed.
5. Diagnosis
 HT
o pubescent female who presents with episodic, cramping lower abdominal
and pelvic pain
o primary amenorrhea
o pelvic mass
 PE
o inspeksi
 LE
o hormon
 SE
o usg
6. Treatment
 The traditional treatment is surgical hymenectomy with T, X, plus, or cruciform
incisions and removal of excess hymenal tissue. It is a simple procedure and
yields good results. However, it may result in social problems for some girls, due
to destruction of the hymen that represents a symbol of virginity in some
cultures.
 There is another technique using the Foley catheter that represents an adequate
alternative when preservation of the hymen is required
7. Complication
a. perineal mass may cause mechanical obstruction of the urinary tract, leading to
urinary retention, hydronephrosis, or acute renal injury