A girl with episodic abdominal pain

A 12-year-old girl presented to our emergency department with diffuse abdominal pain. This episode had lasted 3 days; but she had had several episodes in the preceding months in what appeared to be a cyclical pattern. Her urinary frequency was also increased. She denied any sexual activity and stated that she had never menstruated. She had breast buds and pubic hair confirming the onset of puberty. Transabdominal sonography revealed a pelvic mass measuring about 17x9x8 cm. CT of the abdomen showed severe dilatation of the vagina uterus and even fallopian tube. Perineal examination confirmed an imperforate hymen. The hymen was opened surgically and 1300 mL of menstrual blood was drained from the vagina and uterus. 1 h after the hymenotomy the patients abdominal pain had decreased. She was discharged the following morning without painkillers. 7 days after the operation transabdominal sonography revealed a uterus and vagina of normal size. The patients next menstruation took place 6 weeks after the operation; she had only mild discomfort. Imperforate hymen with retrograde menstruation should not be neglected as a possible cause of cyclical abdominal pain in apparently premenarchal girls. (full text)