Rectovaginal Fistula Due to an Erosive Pessary: A Case Report

Authors

  • Waleed Inayat Mohamed University of Health Sciences
  • Dorea Emmanuel Awali Hospital
  • Shahzaib Maqbool Rawalpindi Medical University
  • Ali Asad Royal College of Surgeons in Ireland - Medical University of Bahrain
  • Asad Jawad Doctors’ Hospital
  • Arham Ihtesham Rawalpindi Medical University

DOI:

https://doi.org/10.5195/ijms.2021.1175

Keywords:

Erosive pessaries, Rectovaginal Fistula.

Abstract

Background: Pelvic organ prolapse (POP) occurs when pelvic organs protrude through the vagina due to displacement from their normal anatomic position, as a result of a weakening of the pelvic muscles. Pessaries have long been used to treat POP, but they may result in rectovaginal fistulas as a rare complication.

The Case: We report a rare case of a rectovaginal fistula following vaginal ring pessary use in an 82-year-old G7P7 woman. She had a past medical history of bipolar disorder, and initially presented for nursing care and psychiatric support. A trained psychologist evaluated her, and found no psychological morbidity. A two-day history of a fall, diffuse abdominal pain, and chronic urinary incontinence were rather identified. Gynecological pelvic examination revealed a rectovaginal fistula and impacted stools in the vagina.

Conclusion: The use of ring pessaries, though a conservative management option for POP, may lead to a rectovaginal fistula, a rare but severe complication.

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References

Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013 Nov;24(11):1783-90.

Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, Spino C, Whitehead WE, Wu J, Brody DJ; Pelvic Floor Disorders Network. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008 Sep 17;300(11):1311-6.

Swift S, Woodman P, O'Boyle A, Kahn M, Valley M, Bland D, Wang W, Schaffer J. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005 Mar;192(3):795-806.

Clemons JL, Aguilar VC, Tillinghast TA, Jackson ND, Myers DL. Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse. Am J Obstet Gynecol. 2004 Apr;190(4):1025-9.

Jones KA, Harmanli O. Pessary use in pelvic organ prolapse and urinary incontinence. Rev Obstet Gynecol. 2010 Winter;3(1):3-9.

Grody MH, Nyirjesy P, Chatwani A. Intravesical foreign body and vesicovaginal fistula: a rare complication of a neglected pessary. Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(6):407-8.

Ozuner G, Elagili F, Aytac E. Rectovaginal fistula secondary to an erosive pessary. Tech Coloproctol. 2015 Aug;19(8):491-2.

Tarr, Megan MD; Culbertson, Sandy MD; Lengyel, Ernst MD, PhD Transverse Transperineal Repair of a Pessary-induced Mid-rectovaginal Fistula, Journal of Pelvic Medicine and Surgery: May 2008 - Volume 14 - Issue 3 - p 199-201

Amshel CE, Tripician NR, Marchetti F, Hellinger MD, Sands LR. Pessary-Induced Rectovaginal Fistula. J Pelvic Med Surg. 2005 Jul;11(4):215-8.

Powers K, Grigorescu B, Lazarou G, Greston WM, Weber T. Neglected pessary causing a rectovaginal fistula: a case report. J Reprod Med. 2008 Mar;53(3):235-7.

Torbey MJ. Large rectovaginal fistula due to a cube pessary despite routine follow-up; but what is 'routine'? J Obstet Gynaecol Res. 2014 Nov;40(11):2162-5.

Cichowski S, Rogers RG. Nonsurgical management of a rectovaginal fistula caused by a Gellhorn pessary. Obstet Gynecol. 2013 Aug;122(2 Pt 2):446-449.

Hanavadi S, Durham-Hall A, Oke T, Aston N. Forgotten vaginal pessary eroding into rectum. Ann R Coll Surg Engl. 2004 Nov;86(6):W18-9.

Reisenauer C, Huebner M. Recto-vaginal fistula after pessary therapy. Arch Gynecol Obstet. 2017 May;295(5):1289-1290.

Asumpinwong C, Leerasiri P, Hengrasmee P. Neglected doughnut pessary in the uterine cavity. BMJ Case Rep. 2019 Apr 14;12(4):e228415.

Sivasuriya M. Cervical entrapment of a polythene vaginal ring pessary--a clinical curiosity. Aust N Z J Obstet Gynaecol. 1987 May;27(2):168-9.

Roberge RJ, Keller C, Garfinkel M. Vaginal pessary-induced mechanical bowel obstruction. J Emerg Med. 2001 May;20(4):367-70.

Vierhout ME. The use of pessaries in vaginal prolapse. Eur J Obstet Gynecol Reprod Biol. 2004 Nov 10;117(1):4-9.

Published

2021-12-16 — Updated on 2022-01-06

Versions

How to Cite

Mohamed, W. I., Emmanuel, D., Maqbool, S., Asad, A., Jawad, A., & Ihtesham, A. (2022). Rectovaginal Fistula Due to an Erosive Pessary: A Case Report. International Journal of Medical Students, 9(4), 304–306. https://doi.org/10.5195/ijms.2021.1175 (Original work published December 16, 2021)