Pelvic Inflammatory Disease Secondary to Vesicovaginal Reflux in an Obese 10-Year-Old Girl

Abstract

Background: Vesicovaginal reflux is a functional voiding disorder seen in prepubertal girls that has been associated with urinary tract infections and daytime incontinence. Childhood obesity is a national epidemic with unrealized implications. We present {Figure presented} a case of pelvic inflammatory disease caused by ves-icovaginal reflux in an obese 10-year-old. Case: A 10-year-old premenarchal girl with A BMI of 35 presented to the emergency department with lower abdominal pain. A CT scan demonstrated hy-drocolpos, consistent with imperforate hymen or transverse vaginal septum. Exam was limited due to patient anxiety. Physical exam under anesthesia showed normal anatomy including a perforate hymen, empty vagina and normal cervix. Laparoscopic examination of the pelvis revealed erythematous, bilaterally clubbed fallopian tubes and omental adhesions to the adnexa. Sexually transmitted infection testing was negative. There was not a history of sexual abuse. Urine culture grew Escherichia coli. Broad spectrum antibiotic treatment and voiding coaching resulted in clinical relief. Follow-up imaging studies demonstrated resolution of the hydrocolpos and pelvic inflammation. The patient's future fertility status is unknown. Comments: Hydrocolpos due to vesicovaginal reflux can result in pelvic inflammatory disease, with unknown consequences for fertility. Obesity may be a contributing factor. Hydrocolpos in the premenar-chal girl may be caused by urine rather than blood (Figures 1 and 2).