Acute Urinary Retention – It Is Not about the Bladder

Chronic cyclical abdominal pain in an adolescent female is indeed a rare occasion. Nevertheless, concomitant presence of acute urinary retention in the background history delayed menarche will give clues towards possibility of imperforate hymen (IH). Nevertheless, adequate physical examination, especially abdominal and gynaecological assessment in the adolescent female is indeed important in making the conclusion. We shared a case of a 12-year-old girl who came to us with recurrent lower abdominal pain for three months associated with inability to pass urine on the day of presentation. Perineum inspection showed bulging hymen with inability to catheterize the urethral opening. Bedside ultrasound was performed and revealed a fluid filled lesion in her vagina showing features of hematocolpos. A diagnosis of imperforate hymen was made clinically, and she was referred urgently to the gynaecology team for surgical intervention. Hymenotomy was done and she was saved from further morbidity. This case highlights the importance of identifying gynaecological causes in a female patient with acute urinary retention especially if the patient had prior episodes of recurrent cyclical symptoms that may be highly associated with imperforate hymen.   Keywords: Hematocolpos, Bladder, Acute Urinary Retention