An ultrasound at Tam Anh General Hospital in Ho Chi Minh City revealed fluid accumulation in the girl's uterus and vagina, pressing on her urethra and preventing urination. This resulted in grade 1-2 hydronephrosis (swelling of the kidneys) and a distended bladder. Dr. Ton Thi Anh Tu, from the Pediatric Surgery Department, explained that if left untreated, an overly distended bladder can cause pressure to build up, affecting the ureters and kidneys, leading to acute renal failure. In severe cases, the bladder could rupture.

The surgical team inserted a catheter to drain the urine, relieving pressure on the bladder, reducing pain, and preventing further kidney damage. They then created a permanent opening to allow menstrual blood to flow normally. The 60-minute procedure was successful, and the patient was discharged after 3 days.

The surgical team operating on the patient. Photo: *Tam Anh General Hospital*

Imperforate hymen is a congenital condition where the hymen, a thin membrane partially covering the vaginal opening, lacks an opening. Normally, the hymen has small holes allowing vaginal secretions and menstrual blood to pass through. If completely closed, it causes fluid buildup.

Symptoms vary with age. In newborns, the trapped fluid is clear mucus due to maternal hormones stimulating cervical secretions. This often presents as a small, white or bluish bulge. Most cases at this stage require monitoring, with intervention only necessary if the fluid accumulation becomes excessive, affecting urination.

During puberty, with the onset of menstruation, the trapped blood can cause severe monthly abdominal pain corresponding with the menstrual cycle, without visible bleeding. The pain may last for several days, subside, and recur the following month with increasing intensity. The accumulating blood can cause swelling and pain in the lower abdomen, pressing on surrounding organs. Pressure on the bladder leads to urinary retention, difficulty urinating, and a constant urge to urinate.

The trapped menstrual blood creates an ideal environment for bacterial growth, potentially causing infections in the vagina, uterus, and fallopian tubes, spreading throughout the pelvic region and harming reproductive organs. Dr. Tu advises girls who haven't started menstruating by puberty or experience cyclical abdominal pain to seek medical attention.

Dinh Lam

*The patient's name has been changed.