Abstract Proceedings EROC 2011 - New York Osteopathic Medical ...

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EROC 2011 Abstract Proceedings – March 4, 2011 Dept. of Pediatrics, Good Samaritan Hospital Medical Center, West Islip, NY Title: A Case of Urinary Retention and Mild, Bilateral Hydronephrosis Due to an Imperforate Hymen Authors: Shannon Henning D.O. (1), Jacqueline Yacenda DO (1), Emily Gubert, M.D. (2), Catherine Caronia M.D. (3), Department of Medical Education (1) Department of Obstetrics and Gynecology (2) Division of Pediatric Critical Care Department of Pediatrics (3), Good Samaritan Hospital, West Islip NY Introduction: The overall specific incidence of an imperforate hymen is unknown, but is considered a rare event. Rarer still is urinary retention secondary to an imperforate hymen that leads to hydronephrosis. The hypothesized cause of urinary retention is secondary to the retained menstrual products in the vagina that causes compression of the posterior bladder wall and urethra into an angulated position thereby preventing urination. Case Description: An afebrile, thirteen-year-old Caucasian female presented to the ED with a history of anuria for twelve hours and severe abdominal discomfort. The patient denied sexual activity or the onset of menses but admitted to an intermittent cramping abdominal pain for several months duration. Physical examination revealed a tanner III female and was within normal limits except for a twenty millimeter mass palpated on abdominal exam to the left of and above the umbilicus and a bulging, lemon-sized, mucosa-covered mass protruding from the introitus. Urinary catheterization revealed five hundred cc of clear urine resulting in a decrease in the size of the abdominal mass. An abdominal ultrasound revealed hematometros-hematocolpos and mild bilateral Hydronephrosis. Surgical incision of the hymen allowed for the drainage of one liter of thick, brown retained menstrual blood. A Urinalysis and urine culture was negative for abnormality or infection. Discussion: Urinary retention secondary to multiple factors such as constipation, urinary tract infection, pelvic disorders, trauma, psychosomatic causes, and posterior urethral valves (in males) are seen in children. However, this case stresses the importance of a complete history and physical examination during annual examinations, in addition to a review of systems on routine evaluation of patients such that possible diagnosis can be made. Thus an imperforate hymen may be diagnosed prior to the secondary presentation of acute urinary retention. 46
EROC 2011 Abstract Proceedings – March 4, 2011 Dept. of Psychiatry, Maimonides Medical Center, Brooklyn, NY Title: Psychiatric Manifestations of Tuberous Sclerosis Author: Polina Shats DO Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, 11219 Introduction: Tuberous sclerosis is characterized by cutaneous lesions, seizures, mental retardation, learning disabilities, developmental delay and behavior problems, such as hyperactivity, aggression, and self-injurous behavior. It is most commonly diagnosed in infancy or childhood. This case illustrates an example of someone who was diagnosed in adulthood, and demonstrates the need to consider a diagnosis of tuberous sclerosis as a rule out for a psychiatric presentation, when seeing a patient with impulsivity, suicidal attempts, and self-injurious behavior because being diagnosed with tuberous sclerosis could have serious implications for the patient and the care givers. Case History: The patient is a 19 year-old Caucasian female with a past history of major depression and polysubstance dependence who was initially hospitalized in a neurology floor after sustaining a seizure. She had one previous psychiatric hospitalization for overdosing on medication and illicit drugs and a history of cutting herself. She was admitted twice to a neurology unit to evaluate the seizure and both times signed out against medical advice. During the second admission on the neurology unit, her MRI showed two small lesions within subcortical white matter. Her outpatient neurologist informed her that she has tuberous sclerosis and as she was being told this, the patient text messaged some of her friends threatening to hurt herself. Patient was hospitalized on an inpatient psychiatry unit because of concern that she would kill herself with intentional heavy drug use. She was discharged to an inpatient rehabilitation unit in California. Discussion: This case illustrates that someone with a history of impulsive behavior and long standing history of self-injurious behavior including cutting, drug use, and suicide attempt should receive further workup to evaluate for tuberous sclerosis. Since tuberous sclerosis is an autosomal dominant genetic disorder, there is an increased need for genetic counseling and periodic surveillance for malignancy. 47
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