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Vaginal foreign body in the pediatric patient: A systematic review
E Umans1, M Boogaerts1, B Vergauwe2
1UZ Brussel, Department of Gynecology-Obstetrics, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium.
Insights
Pediatric vaginal foreign bodies are challenging. Clinical exam and ultrasonography aid diagnosis, while vaginoscopy is key for treatment. Always consider potential sexual abuse in these cases.
Area of Science:
- Pediatric Gynecology
- Diagnostic Imaging
- Minimally Invasive Surgery
Background:
- Vaginal foreign bodies in children present diagnostic challenges.
- Existing literature consists of case reports and small studies, lacking a comprehensive review.
- This systematic review addresses the need for consolidated evidence on pediatric vaginal foreign bodies.
Purpose of the Study:
- To systematically review the literature on vaginal foreign bodies in pediatric patients.
- To identify common presentations, diagnostic methods, and therapeutic approaches.
- To highlight potential complications and associated factors, such as sexual abuse.
Main Methods:
- Systematic review of English-language articles.
- Inclusion of studies on patients aged 16 years and younger with available full text.
- Exclusion of adult patients and cases of abdominal-to-vaginal migration.
Main Results:
- 75 articles involving 522 pediatric patients were analyzed.
- Common symptoms included vaginal bleeding and discharge; toilet paper was the most frequent object.
- Ultrasonography demonstrated 79.9% sensitivity, while vaginoscopy was the primary therapeutic method.
Conclusions:
- Accurate diagnosis relies on clinical examination and ultrasonography.
- Vaginoscopy is the gold standard for diagnosis and treatment of pediatric vaginal foreign bodies.
- Clinicians must remain vigilant for potential sexual abuse in affected children.
Background:
Vaginal foreign bodies represent a clinical and diagnostical challenge in pediatric gynecology. Several case reports, case series and retrospective studies have been published, highlighting rare or complex cases. A comprehensive systematic review is lacking.
Methods:
Published English-language articles on vaginal foreign objects in patients aged 16 years and younger, with full-text availability were included. Articles on adult patients and patients with an object migrating from the abdominal cavity into the vagina were excluded.
Results:
Out of the 215 screened articles 75 were included, comprising a total of 522 patients. The age ranged from 6 months to 16 years, with an average of 6 years and 3 months. The presenting symptoms were documented in 340 patients, with the two most common being vaginal bleeding (n = 172) and vaginal discharge (n = 134). Toilet paper or tissue was the most common object, in 155 out of 447 patients. Ultrasonography was the most utilized diagnostic method, with a sensitivity of 79.9 %. Radiography showed more false-negative than true-positive results, with a sensitivity of 33.3 %. Complications were reported in 35 patients. Evidence of sexual abuse was found in a small group of 16 patients. Vaginoscopy under sedation was the most frequently used therapeutic approach.
Conclusion:
A swift and accurate diagnosis is crucial, with clinical examination and ultrasonography playing pivotal roles. Vaginoscopy is the gold standard for definitive diagnosis and therapy. Attention should be given to a potential context of sexual abuse.
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