(14) An Unusual Case of Hematometrocolpos in a Young Patient with Acute Myeloid Leukemia

Background: Hematometra and hematocolpos are uncommon conditions involving fluid accumulation in the uterus and vagina, often due to primary or secondary outflow obstruction. Their occurrence in young patients, particularly those with hematologic disorders, poses diagnostic challenges and can lead to significant morbidity. This case report aims to enhance awareness of acquired hematometrocolpos resulting from graft versus host disease (GvHD) in a post-hematopoietic stem cell transplant patient.

Case: A 17-year-old female with a history of acute myeloid leukemia presented with severe pelvic pain after treatment for cancer, GvHD, and premature ovarian insufficiency. Evaluation revealed significant hematocolpos and a distended uterus to 16 cm. Diagnostic laparoscopy and hysteroscopy identified atrophic vaginal and cervical tissues with substantial adhesions. Approximately 300 cc of dark blood was drained, and a levonorgestrel-releasing intrauterine device was placed. Despite initial improvement, the patient experienced recurrent hematocolpos requiring repeat surgical decompression. She is currently doing well with vaginal estrogen and dilators to maintain patency.

Comments: This case highlights consideration of hematometrocolpos in adolescents with complex medical histories, particularly those undergoing treatment for hematologic malignancies. Early recognition and intervention can prevent long-term complications and improve patient outcomes. Continued education on the implications of GvHD on the female genital tract is essential for optimizing care in this vulnerable population.