A New Application for Bolt Cutters in Urogynecology: Challenging Removal of an Impacted Pessary

Pessaries are commonly used to treat pelvic organ prolapse. While these devices generally pose negligible risk, serious morbidity can be associated with neglected use.

A 91-year-old woman began to experience acute pain related to an impacted pessary. An Exam in the operating room under anesthesia revealed that the pessary was deeply embedded within the vaginal canal and was noted to have a hard metal wire under a rubber exterior. An intraoperative orthopedic consult was obtained to facilitate discussion and selection of tools outside the typical gynecological scope to remove the pessary. A combination of bolt cutters and rongeur forceps were used to successfully remove the pessary.

Consideration of instruments outside traditional gynecology including bolt cutters may be considered when faced with a difficult removal of foreign bodies embedded in gynecological tissues.