Yasmine I.M. El-Masry, Ahmed M.E. Ossman, Ayman Abdelaziz Eldorf
lecturer of Obstetrics and Gynaecology department, Faculty of Medicine,Tanta University,, Egypt. Associate professorof Obstetric sand Gynaecology department, Faculty of Medicine,Tanta University,Egypt. Professor of Obstetrics and Gynaecology department, Faculty of Medicine, Tanta University, Egypt.
Scientific Tracks Abstracts: J Women’s Health Care
Imperforate hymen (IH) is considered the most common obstructive anomaly of the female reproductive tract. Infections, endometriosis, subfertility or obstructive urinary symptoms could complicate if went undetected. Treatment of uncomplicated IH is simple through hymenotomy (cruciate incision or excision of hymen). In case of patients desiring virginity hymen-preserving surgeries is an alternative choice, such as simple vertical incision and annular hymenotomy. Sepsis is not common to occur secondary to imperforate hymen, but this case highlights it as a possible and evitable cause of sepsis in pediatrics’ and adolescence. Pyometra is rarely seen in children and clinical experience in managing this condition is limited. Severe sepsis or septic shock in children is associated with high mortality, especially in developing countries, and accounts for about 8% pediatric intensive care unit (PICU) with estimated mortalities of about 25%, more over about 17% of survivors may show moderate disabilities. This review reported a rare case scenario with uncommon sever presentations seen in adolescent gynecology, and it is a serious case and fortunately the pediatricians, emergency room physicians and gynecologists are rarely facing such issue. We provided our valuable experiences in the approaches of diagnosis and treatment for imperforate hymen that complicated with pyocolpus & pyometra and extremely rare & sever sepsis caused by virulent Klebsiella strains in children which is extremely rare to infect them. Case presentation: we described diagnosis and management of such rare complicated case in a 14-year-old adolescent girl with an undetected imperforate hymen that was complicated by pyocolpus, pyometra, sepsis and the first presented as acute urine retention, acute renal failure and septic shock in an adolescent girl. Condition was managed by urgent resuscitation then under general anesthesia, partial, central & cruciate hymenotomy was done and the patient was underwent peritoneal dialysis continued her treatment in ICU. Conclusion and importance of the research; beside the easiness of detecting and managing Imperforate hymen, it represents an evitable cause to more serious side effects such as acute urine retention, sepsis and subfertility. Suspicion should be raised for IH in adolescent girls presented with acute abdomen, urinary manifestations, and urinary emergencies for example acute retention, renal colic & acute renal failure. There is much to be learnt about how Klebsiella disseminates from the primary infection site, either the lung or the gut, to other sites. One troubling aspect of K. pneumoniae infections is the emergence of strains causing disseminated pyogenic infections. Although these strains are not generally associated with UTIs, they are clearly genetically related bacteria and present the potential to transfer, either directly or indirectly, genetic information into urinary isolates. Challenges that face the future management of these infections include the development of non-antibiotic based therapies since the ability of K. pneumoniae to rapidly evolve to antibiotic-resistant strains is alarming. The increased quality of healthcare has resulted in a greater population of susceptible hosts for K. pneumoniae infection. The prevention of infection and management of patients with infections will provide enormous challenges in the future. Keyword: imperforate hymen, pyocolpus, pyometra, septic shock, Klebsiella, hymenotomy, adolescents.
Yasmine El-Masry has completed the MD in obstetrics and gynecology at the age of 35 years old from Tanta University, Egypt. She is a lecturer in obstetrics and gynecology department, faculty of medicine, Tanta University. She has 4 international publications and others are ongoing to be published in the near future.