4 month od female child was reffered to KATH paediatric surgery team presenting with 1. Inability to pass urine adequatelly for 3 months 2. Abdominal distension for 3months Child is the last born of six children born to a 45 year old mother.She  was observed to have difficulty in pasing urine 2 weeks after delivery. this was associated with progressive abdominal distension. Child’s mother had visited few district hospitals where urethral catheterisation was done and child discharged home . The condition still persisted and so child was referred. Child feeds well , does not vomit, passes stoosl normally. There is significant family history
Examination :
weight 5.2kg ,  HR 142, RR 40 , Temp 38deg C, CRT<2s hydration fair, anicteric
Chest : Air entry reduced at lung bases, bilaterally
Abdomen : grossly distended, moved with respiration, Bilaterally palpable firm masses in lumbar regions
Genitalia : examinaton of vulva showed a cystic bulge at 6 O’clock of introitus, external urethral meatus catheterised draining clear urine
Diagnosis: Lower urinary tract obstruction secondary to hydrocolpus complicated by bilateral hydronephrosis
Investigations :
Abd USG : bilateral hydronephroureters 2  cystic mass in pelvis
FBC :13.1g/dl, WBC 16.21
BUN : 1.88  Creat N/A
Electrolytes : Na 137  ,K 3.8 , Cl 111
Decision taken to perform a vaginostomy
Surgery : Vaginostomy
Findings : 400mls of purulent fluid in vagina
Procedure :
1.Cruciate incision made over hymen to drain fluid.
2. Hymen marsupialised.

Post surgery : Resolution of abdominal distension in immediate post op period
Credits : Dr Yifieyeh ( Peadiatric surgeon), Dr Luri Prosper (Resident), Dr Opuni ( Specialist , General surgery )