Une jeune fille de 11 ans était adressée pour un syndrome appendiculaire. La laparotomie révélait un hémopéritoine brunâtre et une dilatation de la trompe de Fallope droite, alors que l’appendice paraissait sain. Une appendicectomie de principe était, malgré tout, réalisée. Le diagnostic d’hématocolpos compliqué d’hématométrie avec hématosalpinx et hémopéritoine était alors suspecté. L’inspection vulvaire confirmait l’imperforation hyménéale avec une collection sus-jacente tendue visualisée en échographie pelvienne sus-pubienne et endorectale. Une hyménotomie permettait l’évacuation de 400cc d’un liquide « chocolat ». L’interrogatoire rétrospectif révélait des douleurs abdominopelviennes récidivantes motivant de nombreuses consultations au service des urgences. Les suites s’avéraient simples permettant la sortie de la patiente au 2^e j postopératoire.

A case of imperforate hymen discovered after a surgical complication is reported. We discuss the lessons to draw from this case in terms of diagnosis and therapeutic management.

An 11-year-old girl was referred with fever and acute lower abdominal pain. A diagnosis of appendicitis was hypothesized because of rigidity located to the right iliac fossa, a psoas sign, polynuclear leukocytosis, and increased serum C-reactive protein. A McBurney laparotomy showed a brownish hemoperitoneum and a dilated right fallopian tube. The appendix appeared normal and an appendicectomy was done. A diagnosis of hematocolpos aggravated by hematometra, hematosalpinx, and hemoperitoneum was suspected. Pelvic examination revealed an imperforate hymen with a taut pelvic mass confirmed by transabdominal and endorectal ultrasonography. Hymenotomy was performed, which allowed the discharge of 400cc of chocolate-colored fluid. The history-taking revealed recurrent intermittent lower abdominal pain with several referrals to emergency departments. The patient recovered uneventfully and was discharged 2 days later.

In case of acute abdominopelvic pain in pubertal girls with no previous menstruation, the possibility of an imperforate hymen must be suspected. Examination should include observation of secondary sexual characteristics and inspection of the external genitalia. Treatment is surgical and consists of a hymenotomy.