The Dangerous Vaginal Pessary

Russell, J. K.

doi:10.1097/00006254-196206000-00034

Cited by 7 publications

(11 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

See 1 more Smart Citation

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

Gordon¹,

Dolnicek²,

Malviya³

2015

J Clin Gynecol Obstet

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…Others are incarceration, ulceration and metaplasia 3 , intestinal obstruction 4,5 , urosepsis and hydronephrosis [6][7][8] . Russell 9 reported seeing 14 patients with complications over a 4-year period: one woman had a rectovaginal fistula, the pessary having been in place for 18 years; the others had vaginal cancer (7) or chronic vaginitis (6).…”

Section: Commentmentioning

confidence: 99%

An Erosive Pessary

Kankam

Geraghty

2002

J R Soc Med

View full text Add to dashboard Cite

Pessaries inserted for uterine prolapse are easily forgotten in the old, and can be hazardous. CASE HISTORYA woman of 88 was admitted after a fall at home. Her medical history included chronic atrial fibrillation, cerebrovascular disease, osteoarthritis, and utero-vaginal prolapse. She reported a three-month history of constipation interrupted by bouts of diarrhoea, weight loss, lethargy and a decline in mobility. On examination she was frail, malnourished and dehydrated. There were hard faeces in the rectum. Respiratory and abdominal examinations were normal. Plasma urea was 13.37 mmol/L, albumin 27 g/L. Abdominal X-ray revealed faecal loading throughout the colon.The patient was rehydrated and her constipation was treated with faecal softeners and enemas. It was then noticed that she was passing faeces per vaginam. On enquiry she said this had happened on several previous occasions. A hard rubbery object was now felt in the rectum, and a soluble-contrast enema established the presence of a rectovaginal fistula. On colonoscopy a vaginal pessary was identified eroding through the upper rectum; impacted faeces were evacuated and multiple biopsies were taken (no evidence of malignancy). A pelvic examination was performed simultaneously and a shelf pessary was removed. The cervix was normal, the uterus was small and mobile, and no adnexal masses were palpated. Closure of the fistula was attempted per rectum but this subsequently failed. Pneumonia and upper gastrointestinal bleeding complicated her postoperative recovery and she died two months later. COMMENTVaginal pessaries are devices of varying composition (rubber, clear plastic, silicone, or soft plastic with internal mouldable steel reinforcement) that serve to reposition and support prolapsed genitourinary organs 1 . Various shapes and sizes are available to provide comfortable anatomical support. In the UK, ring and shelf pessaries are commonly used.Although surgery is the definitive treatment for severe uterine prolapse, pessaries can give satisfactory results in women who wish or need to avoid surgery 2 . Complications are usually due to inadequate hygiene-e.g. leucorrhoea, cellulitis, abscess formation. Others are incarceration, ulceration and metaplasia 3 , intestinal obstruction 4,5 , urosepsis and hydronephrosis 6-8 . Russell 9 reported seeing 14 patients with complications over a 4-year period: one woman had a rectovaginal fistula, the pessary having been in place for 18 years; the others had vaginal cancer (7) or chronic vaginitis (6).In retrospect, questioning our patient about pessary use at the time of admission could have resulted in more prompt diagnosis. However, most internal physicians have little experience with these devices; furthermore, pelvic examination tends to be omitted in elderly patients unless specifically indicated. When an elderly woman is fitted with a pessary, long-term follow-up is desirable-especially if she has dementia 2,3 .

show abstract

“…Pessaries are known to cause vaginal irritation, allergic reactions, leucorrhoea, ulceration, bleeding and cancer. 2,3 Ideally, pessaries should be removed and cleaned every 6 weeks. 4 With a growing elderly population, the use of vaginal pessaries is increasing.…”

mentioning

confidence: 99%

“…On literature review, there were only 2 reports of this complication. 3,5 Other rare, but serious, complications reported from pessary neglect included small bowel obstruction, 6 small bowel prolapse and incarceration, 7 erosion into the bladder, 8 and urosepsis and hydronephrosis. 9,10 Although vaginal pessaries are effective in treating uterine prolapse, care must be taken to avoid serious complications.…”

mentioning

confidence: 99%