28-Year-Old Pregnant Female Patient with Abdominal Tumor on Fetus

• 28-yr-old pregnant woman at 30 wk gestational age presents for evaluation because of prenatal ultrasound of fetus with concern for abdominal tumor.
• Ultrasound was repeated 6 wk after the initial ultrasound. On repeat ultrasound at 36 wk, the mass is noted to be in the pelvis, posterior to the bladder identified to be hydrocolpos.
• MRI was obtained to help identify the anatomy.
• The baby was born before the MRI was scheduled. MRI was obtained on day of life 2 that showed a large mass with fluid, bladder, cervix and uterus.
• Thorough examination of the perineum was performed.
• The mass was palpable transabdominally. Anus and the urethra were normal. A bulging structure was noted where the vaginal introitus should be.
• With these findings, the patient was diagnosed with a low transverse vaginal septum/imperforate hymen.
• An introitoplasty was performed.

Takeaways

• Draining the hydrocolpos helps to protect the kidneys and prevents infection.
• It is important to evaluate the status of the spine, kidneys, and sacrum on the prenatal imaging.
• For patients with cloaca and hydrocolpos, the hydrocolpos should be drained first then re-evaluated for hydronephrosis and megaureter after 48 to 72 hr.