Forgotten vaginal pessary eroding into rectum

Hanavadi, Satheesha; Durham-Hall, A.; Oke, Tayo; Aston, N. O.

doi:10.1308/147870804182

Cited by 35 publications

(19 citation statements)

References 8 publications

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“…35 Fistula formation may also be associated with fecal impaction, hydronephrosis, and urosepsis, 32 however, these complications were generally reported in the setting of neglect. 22,23 Although serious complications caused by neglected pessaries are rare, 49 in case reports describing VVFs, bowel fistulae, and incarcerated pessaries, 91% were correlated to neglected pessaries, 12 and patients with dementia and nursing home residents could be at higher risk. 39 Several reports implicated pessaries as a causal mechanism for both vaginal and cervical cancer.…”

Section: Discussionmentioning

confidence: 99%

An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

Abdulaziz

Stothers

Lazare³

et al. 2015

CUAJ

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Introduction: Pessary use is the preferred non-surgical treatment option for female pelvic organ prolapse. As pessaries can be used chronically to alter pelvic floor anatomy, consideration of shortand long-term complications is important in patient management. We systematically reviewed articles describing the complications of pessary use to determine frequency and severity. Methods: A systematic search via MEDLINE and PubMed using the key terms "complications," "pessary," "pelvic organ prolapse," "side effects" was conducted for the years 1952 to 2014 inclusively. Selected articles cited in the publications identified were also considered. Only full-text material published in English was reviewed. All pessary-related complications described were collated; overall frequency within case reports and case series were calculated and severity was graded using the Clavien-Dindo classification. Results: In total, 61 articles met the inclusion criteria. The most common complications reported were vaginal discharge/vaginitis, erosion, and bleeding. Complications were related to pessary shape and material, and duration in situ. Clavien-Dindo classification of complication severity found that all 5 grade levels were attributed to pessary use; serious grade 4 and 5 complications included cancer, adjacent organ fistula and death. Conclusion: There are few detailed reports of complications of pessary use relative to the estimated frequency of pessary use worldwide. Prospective studies documenting complications by shape, material, and size, and objectively classifying complication severity are required. As serious grade 4 and 5 complications of pessary use occur, further development of clinical follow-up guidelines for long-term pessary users is justified.

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Section: Discussionmentioning

confidence: 99%

An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

Abdulaziz

Stothers

Lazare³

et al. 2015

CUAJ

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“…An extensive literature search revealed a total of eight reported cases of recto-vaginal fistulas secondary to pessary usage [4][5][6][7][8][9][10]. The age range for the reported cases was 70 -88 years old.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical management is frequently recommended and undertaken. Management of a diverting loop colostomy has been documented in two other cases [4,5] and was planned in a third where the patient was lost for follow-up prior to surgery [6]. Other reported surgical methods of management include transvaginal repair with a graft [7], transperineal repair [8], and transrectal repair, which subsequently failed [9].…”

Section: Discussionmentioning

confidence: 99%

A Problematic Peril of Pessaries: The Rare Case of Rectovaginal Fistulas Resulting From Pessary Use

Gordon¹,

Dolnicek²,

Malviya³

2015

J Clin Gynecol Obstet

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Pelvic organ prolapse (POP) is a condition of herniation of the pelvic organs into the vagina or past the introitus. Management options include pessary use. A very rare complication of pessary usage is erosion resulting in a vesicovaginal or rectovaginal fistula. We present two cases of patients who were found to have rectovaginal fistulas from Gellhorn pessary usage. Both patients were surgically treated with colostomies. Pessary management of POP is very common and accepted form of treatment. For optimal outcomes with pessary use, we recommend that patients be actively managed with individualized periodic evaluations. Estrogen cream may be considered for prevention and treatment of eroded vaginal epithelium.

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“…Weitere seltene Ursachen einer rektovaginalen Fistel stellen Erosionen durch Fremdkörper (v. a. belassene Intrauterinpessare) dar [8,44,107,140,226,238]. Eine Literaturübersicht findet sich bei Arias et al [13].…”

Section: Postpartale Rektovaginale Fistelnunclassified

S3-Leitlinie: Rektovaginale Fisteln (ohne M. Crohn)

Ommer¹,

Herold²,

Berg³

et al. 2012

coloproctology

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Rektovaginale Fisteln (RVF) sind definiert als mitEpithel ausgekleidete unnatürliche Verbindungen zwischen Rektum und Vagina. Die Häufigkeit wird mit etwa 5% aller anorektalen Fisteln angegeben [287]. Durch Abgang von Luft und Sekret bzw. Stuhl aus dem Rektum über die Scheide resultiert die psychosoziale Belastung der betroffenen Frauen. Diese nimmt mit dem Durchmesser der Fistel zu. Folgen können rezidivierende Entzündungen sowohl der Vagina als auch der unteren Harnwege sein. Bezüglich der Ätiologie müssen verschiedene Typen unterschieden werden. Ursachen stellen v. a. Entbindungstraumata und iatrogene Fisteln nach Eingriffen im Damm-und Becken bereich dar. Auch die Entstehung über lokale Entzündungen und Tumoren ist möglich. Ziel dieser S3-Leitlinie ist die Darstellung des Krankheitsbildes und der Therapieoptionen auf der Basis einer evidenzbasierten Aufarbeitung der vorhandenen Literatur.

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Forgotten vaginal pessary eroding into rectum

Cited by 35 publications

References 8 publications

An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse

A Problematic Peril of Pessaries: The Rare Case of Rectovaginal Fistulas Resulting From Pessary Use

S3-Leitlinie: Rektovaginale Fisteln (ohne M. Crohn)

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