Maryam M., 18

Maryam Muhammad was the second of the family with 2 siblings Ali and Musa her mother name is Fatima she sell grants at home and her father Malan Muhammad is a farmer the both leaves together at karasuwa village. Maryam ​arrived at the hospital with several significant issues that had been ongoing for four years: ​Primary Amenorrhea: She had never had a menstrual period, despite being past the typical age of puberty. She has been experiencing severe lower abdominal pain that occurred "every end of the month." This is a classic sign that her body was trying to menstruate, but the blood had nowhere to go. She had a physical swelling in her abdomen reaching up to her belly button (umbilical region). ​Doctors performed a physical exam and an ultrasound, which revealed ​Imperforate Hymen which is a congenital condition where the hymen has no opening from which the menstrual blood could flow out hence trapping it. ​Hematocolpus then develops because there was no opening, the menstrual blood from the last four years had backed up and filled the vaginal canal and uterus. This created a "huge pelvic mass" seen on the ultrasound. ​Urinary Retention was a complication of the mass of trapped blood was so large that it was pressing against her bladder/urethra, making it difficult for her to urinate. She is in urgent need of a procedure to perforate the hymen and evaluate backed up blood and also allow free flow of urine. She is associated severe abdominal pain, infection, and bladder/kidney problems.

Maryam was admitted with a diagnosis of imperforate hymen, presenting with lower abdominal pain and obstruction of menstrual flow. Treatment: She underwent hymenotomy (surgical incision of the hymen) to create an opening and allow drainage of retained blood and restoration of normal menstrual flow. Postoperatively, she was managed with analgesics including Paracetamol and Ibuprofen for pain relief and inflammation control. She also received antibiotics such as Ceftriaxone and Metronidazole to prevent postoperative infection. In addition, wound care and antiseptic dressing were maintained, and she was closely monitored for bleeding and urinary function. Recovery: Maryam responded well to treatment. Pain subsided, normal menstrual flow was established, and no postoperative complications were observed. The surgical site healed properly. She was discharged in stable condition with instructions on hygiene, medication adherence, and follow-up visits for proper healing and assessment.

Maryam was brought to Ayaji hospital with experienced severe lower abdominal pain that occurred "every end of the month." This is a classic sign that her body was trying to menstruate, but the blood had nowhere to go. ​Abdominal Swelling: She had a physical swelling in her abdomen reaching up to her belly button (umbilical region). ​Immediate Relief: Surgery typically provides instant relief from abdominal pain and urinary retention And she was diagnosed with imperforate hymen leading to hematocolpus which requires attention to be treated immediately. The patient was advised with following Important Consideration ​Follow-up: It is crucial for the patient to attend all follow-up appointments to ensure the surgical opening remains open and heals correctly without excessive scarring (which could cause the opening to close again). ​Hygiene: Post-operative care instructions from the surgeon regarding hygiene are vital to prevent infection during the healing phase.