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Neglected pessary causing a rectovaginal fistula: a case report
Kenneth Powers1, Bogdan Grigorescu, George Lazarou
1Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10467, USA. hoppowers@aol.com
The Journal of Reproductive Medicine
|April 30, 2008
Summary
Neglected pessaries can cause serious complications like rectovaginal fistulas. A two-stage procedure involving pessary removal and surgical repair is necessary for managing these rare but severe cases.
Area of Science:
- Gynecology
- Colorectal Surgery
Background:
- Pessaries are safe for managing symptomatic vaginal prolapse when properly maintained.
- Neglected pessaries can lead to complications such as impaction, erosion, and fistula formation.
- Rectovaginal fistulas secondary to pessary use are infrequently reported in medical literature.
Observation:
- A case of a 70-year-old woman with an impacted Gellhorn pessary is presented.
- The impacted pessary was lodged within the rectal lumen, necessitating transanal removal under anesthesia.
- Pessary removal resulted in a large rectovaginal fistula.
Findings:
- Impacted vaginal pessaries can cause significant rectovaginal fistulas.
- Management of pessary-induced rectovaginal fistulas requires a two-stage surgical approach.
- The first stage involves pessary removal and fistula assessment; the second stage focuses on surgical repair with bowel preparation.
Implications:
- Clinicians must emphasize proper pessary maintenance to prevent severe complications.
- Prompt diagnosis and management are crucial for patients with neglected pessaries.
- This case highlights the importance of recognizing and treating rare complications of pessary use.
