A Case of Hydronephrosis

Hydronephrosis is the dilation and distension of the renal pelvis that usually results from the interruption of the flow of urine, and its causes are multiple.

A 13-year-old female, with no personal or family history of uropathy, Tanner stage M4P4A2, without menarche. She goes to the Emergency Department for right lumbar pain, with five days of evolution and difficulty urinating, without fever. 

On observation, she had positive renal murphy and a painless palpable mass in the right iliac fossa, approximately 5 cm in diameter. No changes in blood count or urine (negative summary and bacteriological examination). The ultrasound revealed a dilatation to the right of the excretory cavities (19mm pelvis), an image suggestive of calculus in the terminal segment of the ureter with 12mm and a large collection of blood from the vagina to the uterine fundus (hematocolpos). Gynecological observation confirmed the suspicion of imperforate hymen. She underwent defloration (under general anesthesia) and about two liters of blood were drained, with complete resolution of the hydronephrosis (Figures 1&2).

Figure 1:  Renal ultrasound: Dilation of the excretory cavities (right pelvis: 19mm).

 Figure 2: Pelvic ultrasound: oval image; not pure content; well defined contours posterior to the bladder – Hydrometrocolpos

We present the case for its rarity and importance of carrying out a complete and rigorous objective examination. The usefulness of ultrasound as a means of diagnosis and the multiple causes of obstructive uropathy are highlighted.

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

The authors declare that they have no competing interests.

JSM, SF, AR contributed equally to the concept, clinical management of the patient, writing of the paper, manuscript review and editing. All authors approved the final version. 

Availability of Data All relevant data are provided in the manuscript.

1. Mou JW, Tang PM, Chan KW, Tam YH, Lee KH (2009) Imperforate hymen: cause of lower abdominal pain in teenage girls. Singapore Med J 50: 378-379.
2. Tonda CG, González ES, Espuelas OS, Hermosa AG, Gorordo Z (1996) Acute urinary retention secondary to an imperforate hymen with hematocolpos. An Esp Pediatr 44: 381-382.