OBSTRUCTED UTERUS

 Hydrometrocolpos and Hematometrocolpos

Obstruction of the genital tract results in the accumulation of secretions and blood in the uterus(metro) and/or vagina(colpos), with the location depending on the amount and level of obstruction. Before puberty, the accumulation of secretions in the vagina and uterus is referred to ashydrometrocolpos. After menstruation,hematometrocolpos results from the presence of retained menstrual blood. The obstruction may be congenital and is usually caused by animperforate hymen. Other congenital causes include avaginal septum orvaginal atresia, or anoncommunicating rudimentary uterine horn.Hydrometra and hematometra may also be acquired as a result of cervical stenosis from endometrial or cervical tumors or frompostradiation fibrosis.

Sonographically, if the obstruction is at the vaginal level, there is marked distention of the vagina and endometrial cavity with fluid. If seen before puberty, the accumulation of secretions is often anechoic. After menstruation, the presence of old blood results in echogenic material in the fluid. There may also be layering of the echogenic material, resulting in a fluid-fluid level. Infrequently, blood may distend only the cervix, which has been termedhematotrachelos.

Acquired hydrometra or hematometra usually shows a distended, fluid-filled endometrial cavity that may contain echogenic material. Superimposed infection(pyometra) is difficult to distinguish from hydrometra on sonography, and this diagnosis is usually made clinically in the presence of hydrometra.

In postmenopausal women endometrial fluid is of particular concern given their increased risk of endometrial cancer owing to age. However, even in this population the accumulation of endometrial fluid is more likely to be from a benign than from a malignant cause. A small amount of fluid within the endometrial canal, detected on TVS, may be a normal finding in asymptomatic patients. Larger amounts of fluid may be associated with benign conditions, most often related to cervical stenosis.

GENERAL FEATURES: -

Etiology

Embryology-anatomy: Failure of canalization, stenosis, or atresia along lumen

In infancy, maternal hormone effects stimulate neonatal uterus & vagina.

Genetics

Generally sporadic; not inherited

McKusick-Kaufman syndrome

Rare multiple autosomal recessive syndrome

Hydrometrocolpos

Postaxial polydactyly

Congenital heart malformation.

Bardet-Biedl syndrome, or Laurence-Moon syndrome.

Also has hydrometrocolpos & postaxial polydactyly with retinitis pigmentosa, obesity, & learning disability becoming apparent by early school age.

Inherited as autosomal recessive trait.

ASSOCIATED ABNORMALITIES: -

Most often associated with anal, renal, vertebral, & cardiac anomalies

Also associated with intestinal aganglionosis, imperforate anus, urogenital sinus, cloacal anomalies.

Can be associated with müllerian duct fusion anomalies, particularly uterus didelphys.

Iatrogenic cases reported due to malposition of artificial urinary sphincter in prepubertal girls.

Site of obstruction can be:-

• Imperforate hymen
• Vaginal stenosis or atresia
• Cervical stenosis or atresia
• Mass effect from duplications of uterus & vagina (didelphys)
• Transverse vaginal septum
• Most common location: Between middle & upper 1/3 of vagina.
• These patients have functional uteri, though fertility can be compromised.

Secondary urinary obstruction can occur at level of:-

Urethra, ureterovesical junction, ureter.

HOMOEOPATHIC MANAGEMENT: -

The medicines that can be thought of use are: -

• Cimicifuga racemosa
• Eupionum
• Lachesis
• Merc Sol
• Pulsatilla
• Platina