Spectrum of Hydrometrocolpos in Pediatric Patients: A Pictorial Essay and Authors' Experience.

CONTEXT: Hydrometrocolpos (HMC) is an uncommon congenital condition affecting females with a range of symptoms that can arise due to various structural abnormalities, including an imperforate hymen, vaginal atresia, transverse vaginal septum, urogenital sinus, cloacal malformations, and rarely syndromic disorders. AIMS: This study aims to deepen the understanding of the diverse manifestations, emphasize the importance of early diagnosis, and explore surgical management strategies to improve outcomes of HMC in pediatric patients. SETTINGS AND DESIGN: An ambispective study was performed in a tertiary care teaching institute from 2016 to 2024. MATERIALS AND METHODS: All pediatric patients with HMC managed by the authors were evaluated for their symptoms, radiological imaging results, associated anomalies, surgical procedures, and treatment outcomes. RESULTS: There were 17 pediatric patients; six showed a vestibular bulge, another eight had an abdominal mass, and three were diagnosed with anorectal malformations. One case was detected before birth, presenting with bilateral hydroureteronephrosis and oligohydramnios. Two patients had complex syndromic associations, including Herlyn-Werner-Wunderlich syndrome and McKusick-Kaufman syndrome. Treatment strategies varied depending on the underlying cause, with simpler cases, including an imperforate hymen and transverse vaginal septum, being managed with incision and drainage, and more complex conditions requiring abdominal vaginostomy. All patients exhibited varying degrees of hydroureteronephrosis caused by lower urinary tract obstruction. CONCLUSION: HMC presents with diverse etiologies, necessitating individualized management approaches. Early diagnosis and comprehensive evaluation are critical in preventing complications and optimizing surgical outcomes. A multidisciplinary approach, integrating pediatric surgery, radiology, and gynecology, is essential for effective diagnosis and management.