An Extreme Case Of Embedded Neglected Pessary Presenting With Pelvic Inflammatory Disease

Abstract

Pessaries have been the major non-surgical treatment option for pelvic organ prolapse POP . However, when the devices are not used appropriately, serious complications and deaths may be occurred. A 78 years old, multiparous woman was hospitalized with diagnosis of pelvic inflammatory disease PID and embedded neglected pessary. In history, it’s learned that a ring pessary was placed 22 years ago due to POP. After the treatment of PID, the adhesions, between the posterior vaginal wall and cervix, was separated by blind and sharp dissection and pessary was removed without any urinary and bowel complications.In a patient who has neglected pessary with symptoms of fever, pelvic-abdominal pain and other symptoms about urinary and intestinal systems need prompt evaluation, diagnosis and treatment. On the other hand, physicians have to be aware of a neglected pessary and not to omit pelvic examination when an elderly woman, especially if she has dementia.

Keywords

• Pessary,pelvic organ prolapse,pelvic inflammatory disease

Pelvik İnflamatuar Hastalığa Sebep Olan Sıradışı Bir İhmal Edilmiş Gömülü Peser Olgusu

Abstract

Peser pelvik organ prolapsusunun konservatif tedavi seçenekleri içinde önde gelen yöntemlerden biridir. Ancak, peserler uygun olarak kullanılmadıklarındahasta kaybına kadar gidebilecek ciddi komplikasyonlara yol açabilmektedirler. 78 yaşında multipar hasta pelvik inflamatuar hastalık ve gömülü peser tanılarıile hastaneye yatırıldı. Medikal hikayesinde, hastaya 22 yıl önce pelvik organ prolapsusu tanısı ile halka peser takıldığı öğrenildi. Pelvik inflamatuar hastalığontedavisini takiben arka vajinal duvar ve serviks arasındaki adezyonlar künt ve keskin diseksiyonlarla ayrıştırılarak, peser üriner veya gastrointestinal herhangibir komplikasyon olmaksızın çıkarıldı. Takipsiz peser hastalarında eşlik eden ateş varsa, pelvik-abdominal ağrı ve üriner-gastrointestinal tüm semptomlar hızlıcadeğerlendirip tanı ve tedavisi sağlanmalıdır. Yanı sıra, değerlendirmelerde özellikle yaşlı demansif hastalarda ihmal edilmiş peser ihtimali akılda tutulmalı ve pelvikmuayene atlanmamalıdır.

Keywords

• peser,pelvik organ prolapsusu,pelvik inflamatuar hastalık

References

1. Bugge C, Adams EJ, Gopinath D, Reid F. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;2:CD004010.
2. Abdulaziz M, Stothers L, Lazare D, Macnab A. An integrative review and severity classification of complications related to pessary use in the treatment off female pelvic organ prolapse. Can Urol Assoc J. 2015;9(5- 6):400-6.
3. Penrose KJ, Ma Yin J, Tsokos N. Delayed vesicovaginal fistula after ring pessary usage. Int Urogynecol J. 2014;25(2):291-3.
4. Kankam OK, Geraghty R. An erosive pessary. J R Soc Med. 2002;95(10):507.
5. Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol. 2001;98(4):646-51.
6. Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013;24(11):1783-90.
7. Smith TA, Poteat TA, Shobeiri SA. Pelvic organ prolapse: an overview. JAAPA. 2014;27(3):20-4.
8. Choi KH, Hong JY. Management of pelvic organ prolapse. Korean J Urol. 2014;55(11):693-702.

9. Sulak PJ, Kuehl TJ, Shull BL. Vaginal pessaries and their use in pelvic relaxation. J Reprod Med. 1993;38(12):919-23.
10. Wu V, Farrell SA, Baskett TF, Flowerdew G. A simplified protocol for pessary management. Obstet Gynecol. 1997;90(6):990-4.