imperforate hymen is reported at an approximate rate of 0,1% and occurs due to the incomplete canalization of the mullerian system and the urogenital system . the treatment of this condition that can be easily diagnosed through gynecological examination is surgical .   in this paper , we present an adolescent girl with a spontaneous ruptured imperforate hymen who is the first case in the literature . gynecological examination of a 13-year - old female patient admitted to our clinic with a cyclic abdominal pain and amenorrhea revealed bulging out of a thinned hymen from the introitus with a blue reflection . furthermore , on rectal examination , a mass lesion of approximately 10  cm in size was palpated and ultrasonography showed a 14  8  cm mass lesion compatible with hematocolpometra . the patient was hospitalized with a diagnosis of imperforate hymen , and hymenotomy was planned . she had severe abdominal and pelvic pain with a dark bloody discharge on the night just before the operation . reexamination revealed an opening with irregular borders in the upper half of the hymenal ring . the ruptured area was assessed to be adequate to provide menstrual drainage , and the patient was decided to be followedup . she was also informed about the possibility of reclosure of the hymen . on her next visit although lower half of the hymen was still closed , it was open in upper half with deflorations at 3 and 9 o'clock positions ( figure 1 ) . hematocolpometra did not exist any more . in her last visit , one year later , her menstruations were still regular and adequate without any complaint . cyclical pelvic pain 2.5 to 4 years after thelarche is the usual presentation in a teenager with imperforate hymen . sometimes it can be fairly asymptomatic , and rarely there is obstruction of the urinary tract from the hematocolpos . with the improving effect of estrogenization on healing this case report is an example of spontaneous hymenal rupture and no similar case report was found in the literature . bakos and berglund   reported a case of acute abdomen due to bilateral hematosalpinx and unilateral rupture of the hematosalpinx owing to an imperforate hymen . in that report , rupture of the tuba was thought to be as a result of distention due to the increased pressure along with hematometrocolpos . similarly , in our case , we think that the retrograde accumulation of menstrual blood leaded to hematometrocolpos , increased intravaginal pressure and perforated the hymen . therefore , when there is an increase in the intensity of pain of an adolescent girl with hematocolpometra , spontaneous rupture of the imperforate hymen should be kept in mind and examination should be repeated . there is a possibility that she can develop a rigid hymen that has to be surgically removed . as a conclusion , the time of spontaneous rupture can not be predicted , and , therefore , waiting for that in an adolescent girl with imperforate hymen should not be recommended . however , hymenotomy may not be needed in cases with spontaneous rupture of imperforate hymen if adequate opening for menstrual discharge is warranted . close followup and operating only the ones with reclosure or inadequate hymenal opening may be logical as far as a minimal invasive approach is concerned .
background . 
 imperforate hymen is usually treated with 
                   hymenotomy , and the management after its 
                   spontaneous rupture is not very well known . 
                   case . in this paper 
 , we 
                   present spontaneous rupture of the imperforate 
                   hymen in a 13-year - old adolescent girl with 
                   hematocolpometra just before a planned 
                   hymenotomy operation . 
 the patient was managed 
                   conservatively with a satisfactory outcome . 
 conclusion . 
 hymenotomy may not 
                   be needed in cases with spontaneous rupture of 
                   the imperforate hymen if adequate opening for 
                   menstrual discharge is warranted .