Hirokazu YAMAZAKI¹, Yumiko CHIDA², Yasuhiro HIRANO¹, Syouji UZU²

¹Hirano Internal Medicine and Urology Clinic, ²Seirei Mikatahara General Hospital

キーワード : transabdominal ultrasonography, imperforate hymen, hematocolpometra, adolescent, primary care

Imperforate hymen is a relatively rare congenital anomaly, but it is the most common anomaly of the female reproductive tract. Diagnosing imperforate hymen is relatively easy for obstetricians and gynecologists. However, patients with imperforate hymen often visit primary physicians, emergency physicians, or pediatricians due to abdominal pain, urinary distention, or lower back pain, and it is difficult to diagnose imperforate hymen using only a description of the symptoms and palpation. The present case report details the transabdominal ultrasonographic diagnosis of imperforate hymen in an 11-year-old female with a 15-day history of increasing abdominal pain, lower back pain, and slight pain during urination. The three transabdominal ultrasound findings essential for the accurate diagnosis of imperforate hymen were: vaginal dilation, anterosuperior location of the uterus, and a fluid connection sign between the vagina and the uterus. We propose that primary physicians can easily visualize the uterus during abdominal ultrasonography by ensuring that the bladder is full, using graded compression, and observing a fixed position. Primary physicians can achieve an early diagnosis of vaginal closure by confirming the presence of the three abdominal ultrasonographic findings, in combination with history taking and palpation.