Congenital Hydrometrocolpos as a Diagnostic Dilemma: A Report of Two Cases From Benin City, Nigeria.

Congenital hydrocolpos/hydrometrocolpos is a rare condition affecting the upper vagina/uterus and upper vagina, respectively, characterized by uterine and vagina dilation as a result of a distal obstruction to the flow of accumulated cervical mucus and secretions. The presentation of this condition may vary from abdominal pain with or without symptoms of urinary or gastrointestinal obstruction. These varied presentations may often confound and delay diagnosis. We present two cases of congenital hydrometrocolpos to highlight the diagnostic dilemma and increase the high index of suspicion. Cases one and two involved a six-week-old infant and an eight-day-old neonate, respectively. Both were only correctly diagnosed intra-operatively with congenital hydrometrocolpos and were managed at this center within a two-year period. Both of them presented with huge cystic intra-abdominal masses and features of urinary and gastrointestinal tract obstruction. Imaging revealed a cystic intra-abdominal mass with a radiologic diagnosis of mesenteric cyst in both cases. They were both worked up and subsequently had an exploratory laparotomy, which revealed a markedly dilated uterus and upper vagina filled with turbid fluid and a transverse intra-luminal septum separating the vagina from the introitus. Intra-operative diagnosis of hydrometrocolpos was made in both cases. Transabdominal drainage of the hydrometrocolpos with utero-vaginostomy and two weeks of vagino-uterine stenting were successful in both cases. Accurate pre-operative diagnosis of this simple yet complex congenital anomaly is still a challenge in the sub-Saharan region. A high index of suspicion in all female neonates/infants presenting with intra-abdominal mass is advocated to improve early diagnosis and commencement of appropriate treatment.