Hydrocolpos néonatal : à propos de quatre cas

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Hydrocolpos is characterized by a vaginal accumulation of cervical and vaginal secretions. It often occurs in newborn child and infant. Imperforate hymen is frequently associated; in rare instances, complete higher vaginal diaphragm or partial vaginal atresia is diagnosed. Hydrocolpos can be treated by hymenectomy using imperforate hymen. Because of additional malformation, the treatment can be more complex for vaginal obstruction. The authors report a series of four patients with hydrocolpos: three neonates and one 2-month old infant. Ultrasonography confirmed the physical findings. Three patients with imperforate hymen underwent hymenectomy in X. The fourth which had a virginal atresia and pyocolpos drainage was treated using celioscopy. The three first patients outcome was favorable except for the patient with pyocolpos who died with septicemia.

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Hydrocolpos and the hydrometrocolpos are anomalies resulting from vaginal and uterine retention and accumulation of cervicovaginal secretions caused by congenital malformation. It is a rare pathology affecting the female newborn and infant and much less often young girls. It appears clinically as an abdominal mass associated with absence or abnormality of the vaginal opening. The diagnosis is confirmed by abdominal echography and CT scan. Treatment varies from the simple X-shaped hymenotomy for the isolated imperforate hymen to major surgery for substantial retentions and complex urogenital abnormalities. The authors report two cases of hydrocolpos and hydrometrocolpos discovered in the neonatal period. These were two newborn babies resulting from poorly followed pregnancies at which the clinical examination noted in both cases a large abdominal mass. The physical examination, imagery and surgical exploration demonstrated the existence of enormous hydrocolpos with imperforate hymen in 1 case and hydrometrocolpos with distal vaginal atresia in the second case. The treatment consisted of draining the secretions for both patients, after an X-shaped hymenotomy for the first and after section anastomosis of the vaginal atresia for the second. Both cases progressed favorably. Copyright © 2012 Elsevier Masson SAS. All rights reserved.
Hydrocolpos is a condition rarely mentioned in the literature. The purpose of this report is to increase the index of suspicion for hydrocolpos in patients with cloaca and to describe our approach for its treatment with the hope that errors in the management of hydrocolpos can be avoided. We reviewed 411 medical records of patients diagnosed with cloaca and managed at our Center during the last 26 years. Emphasis was placed on evaluating for the presence of hydrocolpos, type of drainage, and complications related to the persistence of the hydrocolpos. One hundred seventeen cloaca patients had an associated hydrocolpos (28.4%). Forty-two cases (36%) were initially managed at other institutions at which the hydrocolpos was not drained. Complications experienced by this group included: multiple urinary tract infections (8), hydrocolpos infection (7), sepsis (7), failure to thrive (6), ruptured hydrocolpos (4), and development of hydronephrosis in previously normal kidneys (2). Forty-one patients (35%) had other modalities of treatment, aimed to drain the hydrocolpos, including vesicostomy (26), intermittent perineal catheterization (8), single aspiration (6), or plasty of the perineal orifice (1). In all of these cases, the hydrocolpos persisted or reaccumulated. Thirty-four patients (29%) underwent an effective drainage of the hydrocolpos at birth; 29 at other institutions, 15 with a tube vaginostomy, 13 with a tubeless vaginostomy, and 1 with a catheter placed and left in the vagina through cystoscopy. Five cases had a tube vaginostomy done by us. In all these cases, the vagina remained adequately drained as demonstrated radiologically. Proper drainage of the hydrocolpos alone, with no urologic intervention, dramatically improved the hydronephrosis in 13 cases. Hydrocolpos in patients with cloacas must be diagnosed and treated early in life. Our preferred approach is a transabdominal indwelling vaginostomy tube. The drainage of the hydrocolpos alone may dramatically improve the hydronephrosis, and therefore, we suggest that only after the hydrocolpos is drained should a urological intervention be contemplated. Failure to drain the hydrocolpos can result in serious complications.
Hydrocolpos, found chiefly in the new-born, characteristically presents as a mass in the lower abdomen associated with a cystic bulge at the introitus or an imperforate hymen. There is a membranous obstruction at the vaginal outlet in conjunction with excessive secretion of the glands of the infantile uterine cervix. A vaginogram made by injecting the cyst with radiopaque material helps to confirm the diagnosis. The best treatment is simple incision of the occluding vaginal diaphragm. In 6 of the 40 cases described in the literature since 1940, hysterocolpectomy was done, and the diagnosis was made only after examination of the removed surgical specimen. In 3 of the 4 cases reported by the author the condition occurred in newborn babies; in the fourth it became manifest at the age of 2 months.
We report on a case of duplicated hydrometrocolpos with uterus didelphys, a septate vagina, lower vaginal atresia, a persistent urogenital sinus, left ear agenesis, a single umbilical artery, and an imperforate anus, but without the associated features of McKusick–Kaufman syndrome such as polydactyly and congenital heart defects. Ultrasound-guided fluid aspiration of the fetal intrapelvic cystic mass helped to decompress the distended genital organs, decrease the severity of the urinary tract obstruction, delineate the ultrasonographic image of duplicated hydrometrocolpos to differentiate it from other intrapelvic cystic masses, and obtain fluid for cytological analysis.
The Mckusick Kaufman syndrome is a rare autosomal recessive disorder characterized by a triad of hydrometrocolpos, post axial polydacryly and congenital heart disease. Multiple other anomalies may be associated. A great phenotypic variability ocurs in this syndrome make it very difficult to identify and classify it correctly. A new observation of this syndrome is presented in a female full term new-born of first cousin parents. The prenatal diagnosis of the hydrocolpos is done at the 12 weeks of gestation. Both hydrocolpos and post axial polydactyly allowed to carry the diagnostic of the Mckusick syndrome in this observation without congenital heart disease.
Twenty six cases of hydrometrocolpos in infancy have been recognized during life or discovered at autopsy in the authors' hospital since 1935. There were 10 infants with imperforate hymen or low obstructing vaginal membrane, 13 with atresia or stenosis of the vagina, and 3 with cervical stenosis or atresia. Although imperforate hymen was not associated with other congenital anomalies, all children with stenosis or atresia of the vagina or cervix had other congenital malformations, usually multiple and severe. Fistulae, imperforate anus, bicornuate uterus, and renal hypoplasia were especially common. The resulting anatomic complexity necessitates individualization of the radiologic diagnostic approach. It is clearly worthwhile to obtain as complete preoperative definition of the anatomy as the condition of the child allows.
Two cases of hydrocolpos are described presenting soon after birth. One infant who died on the first day had an intrauterine peritonitis caused by compression of the caecum on the pelvic brim. The other surviving infant developed a caecal perforation secondary to Hirschsprung's disease. Neither infant had rectal atresia, which is the commonest cause of intestinal obstruction in these infants. The association of hydrocolpos with polydactyly in one of these cases may represent an autosomal recessive trait.
Hematocolpos with homolateral renal agenesis is a rare condition. Dysmenorrhea and paroxysmal abdominal pain are common symptoms in adolescent girls. Following a review of the literature, this article considers those procedures and investigations which can be used to help these patients before arriving at the stage of reconstructive surgery.
Hydrocolpos is characterized by a vaginal obstruction with cystic dilatation of the vagina. The latter is usually caused by accumulation of cervical and endometrial mucus but in rare instances urine is accumulated through a vesicovaginal fistula proximal to the obstruction. Hydrocolpos and hydrometrocolpos may be associated with other malformations, such as postaxial polydactyly, anal atresia, esophageal atresia, renal agenesis, genital anomalies, and cardiopathy. Each neonate presenting with hydrocolpos should be evaluated for other clinically silent malformations, such as hamartoblastoma of the hypothalamic region. We report a patient with urinary hydrocolpos and cloacal malformation; it is the first case of hydrocolpos with pre-axial polydactyly. We briefly describe embryogenesis of the different types of vaginal obstruction and discuss prenatal and neonatal diagnosis and differential diagnosis.
The diagnostic circumstances, clinical features and complementary explorations in hematocolpos are discussed. Hematocolpos due to imperforate hymen is treated by simple star incision protecting the Bartholin gland orifices to separate the hymen and the meatus. Hematocolpos resulting from duplex uterus with a blind hemivagina is more difficult to treat. Systematic screening at birth and treatment during infancy is proposed to prevent the development of hematocolpos at puberty.
1. 1. Congenital hydrocolpos is caused by a combination of vaginal obstruction and fetal cervical gland secretion caused by stimulus of the maternal hormones. 2. 2. The vaginal obstruction may be caused by atresia, imperforate hymen, or possibly by a congenital fold of tissue which causes a valvelike obstruction in a partially stenotic vagina. 3. 3. The most important factor in treatment of this anomaly is the establishment of a correct preoperative diagnosis. 4. 4. When the correct diagnosis is made, most of these patients will be cured by a relatively simple transperineal drainage procedure. 5. 5. Long-term follow-up is essential since the distended, hypertrophic vagina and the associated hydronephrosis tend to develop intercurrent infection during their slow return to normal.
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