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- Title
Paediatric interlabial bleeding: More than vaginal pathology.
- Authors
Wong, Zeng Hao Joel
- Abstract
A 10 years old girl was referred with the complaints of "per vaginal bleeding and a mass after cycling". During the first 2 weeks of symptoms, she had visited three different doctors with possible delayed recognition of her diagnosis. Clinical examination revealed an underweight, non-dysmorphic, prepubertal girl with vulvitis and an inflamed interlabial bleeding mass with ulceration. Imaging revealed a subcentimetre arteriovenous fistula and haematoma in the vagina. After one more week (total 3 weeks) of medical therapy, the indication for surgery was worsening of symptoms and failure of medical management. Examination under anaesthesia and cystoscopy revealed a complete urethra prolapse. Dilute adrenaline was injected into the prolapsed mucosa. The prolapse was excised in elliptical segments, and the edges closed with interrupted absorbable sutures. Sub-centimetre segments of mucosa were left between the excised specimens. Bipolar diathermy was used only for hemostasis and circumferential coagulation on the mucosa was avoided. These measures prevent an iatrogenic stenosis. The urethra prolapse was reduced, with no recurrence demonstrated on Valsalva maneuver. Post-operatively, her symptoms resolved. Oral antibiotics, sitz baths, antimicrobial cream and topical estrogen were administered. There was no recurrent urethra prolapse or stricture. The aim of this case report is to increase awareness of the urethral prolapse in the paediatric population and its management.
- Subjects
HEMORRHAGE diagnosis; ESTROGEN replacement therapy; VULVA; DELAYED diagnosis; VULVITIS; HEMATOMA; LEANNESS; ARTERIOVENOUS fistula; VALSALVA'S maneuver; BATHS; URETHRA diseases; OINTMENTS; CUTANEOUS therapeutics; ANTIBIOTICS; CHILDREN
- Publication
Proceedings of Singapore Healthcare, 2023, Vol 32, p1
- ISSN
2010-1058
- Publication type
Article
- DOI
10.1177/20101058221149579