Hydrometrocolpos presenting with acute urinary retention in a neonate

Hydrometrocolpos (HMC) is a rare clinical condition resulting in accumulation of fluid in the endometrial and vaginal cavities secondary to vaginal obstruction. Vaginal obstruction can be caused by imperforate hymen, transverse vaginal septum, vaginal atresia, abnormal vaginal opening, and malformation of the urogenital sinus. Imperforate hymen is the most common cause. Time of presentation can be from the neonatal period to mid-adolescent age and can present as an isolated case or part of a syndrome. The usual clinical symptom is suprapubic abdominal mass. Symptoms from mass effect on surrounding organs, such as urinary retention and constipation, as well as complications of chronic fluid accumulation, such as tuboovarian abscess can be the initial presentation. With a high index of suspicion, diagnosis can be made with adequate clinical history, examination, and imaging. HMC should be considered in female neonates and infants presenting with midline suprapubic intra-abdominal mass irrespective of other clinical presentations.