Pessary in Vagina for 45 Years!

Deathofjocelynn · #1 ● 08-09-2014, 03:18 PM

Pessaries have been used for centuries in the management of uterine prolapse .Vaginal pessaries still have a role in the management of uterine prolapse, particularly in elderly patients. However, they are known to cause serious complications if proper care is not taken. Although surgery is the definitive treatment for severe uterine prolapse, pessaries can give satisfactory results in women who wish or need to avoid surgery1.

Vaginal foreign body is a rare entity, particularly when detected 45 years after its insertion. The associated erosion and granulation over the vagina make its detection difficult. A high index of suspicion can help arrive in a diagnosis of such foreign bodies in women's body who present with foul smelling bloody discharge.
Case

An 87-year- old postmenopausal woman presented with foul smelly vaginal discharge and occasional blood-stained discharge per vaginum. She was primarily brought to the hospital for general ill-health and impaired eating. She is para 9 with 6 child deaths. Her eldest offspring is a son of 62 and the last childbirth was 48 years ago. All were home deliveries without medical assistance.

On further enquiries, she reported that few years after the last child birth she had uterine prolapse and a doctor in a rural health camp treated her. She did not remember much and at present she was suffering from dementia, hypertension and mitral regurgitation, triscuspid regurgitation, aortic regurgitation, left ventricular hypertrophy and polyneuropathies.

Per speculum examination revealed an atrophic shortened vagina with a rim of granulation in the mid vagina, mucopurulent and blood stained discharge was seen. There was erosion and granulation in the vagina, which made it difficult to retrieve the ring pessary even under sedation.
On per vaginal examination, an irregular rim of hard structure was felt in the mid vagina. The examining finger could be negotiated through the rim upto the cervix that appeared normal. An ultrasonographic evaluation showed a ring shaped object in the vaginal area without any other abnormality.

Examination under sedation revealed a black-coloured ring pessary under the granulation tissue impacted in the vagina. It was dislodged and removed with difficulty and there was little oozing from the vagina. Vagina was irrigated with povidine-iodine and vagina was packed with a pack soaked in povidine-iodine. The pack was removed after twelve hours and there was no bleeding from the vagina. As she had vaginitis and trauma during removal she was given a course of antibiotics for five days.

This photo shows the extracted vaginal pessary covered with granulation tissue, pus and blood.

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