Surgical treatment of hematocolpos due to transverse vaginal septum

A case of hematocolpos in a 14 year-old girl is presented. She had himenotomy at other institution without evacuation of hematocolpos due to transverse vaginal septum; she was transferred to our Hospital. She complained of pelvic pain, dysuria, polaquiuria and hypogastric tumor; she had fever and a left pelvic tumor. A transversal septum 1 cm from the introitus closed the vagina. Rectovaginal fistula and tense tumor were present at 6 cm towards the anterior rectal wall. Antibiotics were started and transperineal ultrasound localized the septum, its thickness, diameter and distance from the urinary meatus. Under epidural anesthesia and with bladder catheter, the septum was punctured centrally and 200 mL of foul hemopurulent material was obtained. By traction with three-way Foley catheter filled with saline 30 mL the septum was exposed and cut in ring shape with electro scalpel. The rectovaginal fistula was repaired in three layers. Due to persistence of fever pyosalpinx was resolved at the sixth day by laparoscopy and the patient was discharged on day 16.