Introduction: Hematometra is a blood collection caused by a structural blockage of the vagina or cervix. Most cases of hematometra and/or hematocolpos occur in a relatively rare condition of imperfora..
Introduction: Hematometra is a blood collection caused by a structural blockage of the vagina or cervix. Most cases of hematometra and/or hematocolpos occur in a relatively rare condition of imperforate hymen or Mullerian anomalies in children or adolescent patients. Case: We present a case of a 46 year old G2P2002 with a past surgical history of two C-sections with increasingly severe pelvic pain and abnormal uterine bleeding for the prior five years since her last Cesarean delivery. A large hematometra was found on CT imaging. Pelvic exam showed no vaginal abnormalities and a discolored, pale cervix. Digital pressure led to an incidental rupture of the hematometra and 150ccs of dark red blood were expelled from the cervix. After the incidental rupture, the patient reported a sudden relief of pelvic pain. Discussion: In this case report, we present an unusual case of spontaneous hematometra and background on acquired causes of hematometra and hematocolpos. A case of hematocolpos or hematometra would be unexpected in this patient as she has no history of vaginal deliveries or cervical procedures. We explore the various causes of hematometra and hematocolpos, seek an understanding of the potential etiology behind this patient’s presentation and present a discussion of the adequate follow up as well as considerations of how to best manage this condition. Teaching Points: 1. Most cases of hematocolpos are congenital due to imperforate hymen or secondary to cervical surgery or trauma. 2. Evaluations of hematocolpos include a proper history and physical exam, pelvic exam, and possible Computed Tomography imaging or Transvaginal Ultrasound. 3. Consider providing an antibiotic course in the case of a ruptured hematometra prior to discharge.
