Recurrent Abdominal Pain in a Premenarchal Girl: A Missed Diagnosis of Hematocolpos Identified by Point-of-Care Ultrasound

Hematocolpos is a rare but clinically significant cause of abdominal pain in peripubertal females and may be misdiagnosed as more common conditions such as constipation. We report a case of a girl aged 10 years and 10 months with multiple emergency department visits for recurrent abdominal pain, initially attributed to constipation with unremarkable prior imaging. She presented again with persistent symptoms and no history of menarche despite signs of puberty. Physical examination revealed findings suggestive of hematocolpos. Point-of-care ultrasound (POCUS) demonstrated a distended uterus, which was confirmed on formal ultrasonography. The patient was diagnosed with hematocolpos, likely secondary to an imperforate hymen, and underwent hymenectomy with a good outcome. This case highlights the importance of considering gynecologic etiologies in peripubertal females with abdominal pain and the utility of POCUS in early diagnosis.