Neonatal hydrometrocolpos secondary to vaginal atresia causing obstructive uropathy and renal dysfunction

Background Hydrometrocolpos secondary to congenital vaginal atresia is a rare neonatal anomaly, usually diagnosed during puberty, resulting from obstructed uterovaginal secretions under maternal estrogen influence, which rarely leads to urinary tract compression, obstruction and renal dysfunction. Case presentation We report a preterm 33-week neonatal Asian female delivered by normal vaginal delivery. Antenatal ultrasound revealed bilateral enlarged kidneys, ascites, and polyhydramnios. Postnatally, she developed sepsis, and elevated serum creatinine levels. Abdominal ultrasound and magnetic resonance imaging showed a cystic abdominopelvic mass with enlarged kidneys. Exploratory laparotomy confirmed congenital vaginal atresia. Following surgical intervention, the patient stabilized, with marked improvement in renal function. Conclusion Although congenital vaginal atresia is usually diagnosed at puberty, it can present in the neonatal period; early diagnosis and appropriate management are crucial to prevent complications and achieve favorable outcomes.