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Vaginal pessary: a culprit for intraperitoneal bladder perforation.
Ankit Gupta1, Chandrakala Channappa2, Mohamed Abdelkhalek Ramadan Ibrahim Elsheikh2
1School of Medicine, University of Leeds School of Medicine, Leeds, UK ankit.gupta@nhs.net.
BMJ Case Reports
|April 3, 2024
Summary
Vaginal pessaries can cause serious complications like bladder rupture, even with proper use. This case highlights the importance of patient education on potential risks associated with pelvic organ prolapse devices.
Area of Science:
- Urology
- Gynecology
- Surgical Case Reports
Background:
- Vaginal pessaries are common for pelvic organ prolapse (POP).
- While generally safe, complications can arise from improper use, device design, or material.
- Patient education on potential risks is crucial.
Observation:
- A woman in her 70s presented with severe abdominal pain and distension 2 days post-vaginal pessary insertion for grade 3 vaginal vault prolapse.
- She exhibited acute kidney injury and metabolic acidosis.
- Imaging revealed suspected bladder perforation, later confirmed as an intraperitoneal bladder rupture.
Findings:
- The patient's presentation indicated a rare but severe complication of vaginal pessary use.
- Computed tomography cystogram confirmed an intraperitoneal bladder rupture.
- Emergency surgical repair was required.
Implications:
- This case underscores the importance of recognizing and managing rare complications associated with vaginal pessaries.
- Enhanced patient counseling regarding potential risks, including bladder injury, is essential for safe pessary management.
- Prompt diagnosis and surgical intervention are critical for favorable outcomes in cases of bladder rupture.
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