Conservative management of a rectovaginal fistula caused by a Gellhorn pessary. A case report
Published: 21 November 2024
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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A 72-year-old woman presented with stage III pelvic organ prolapse (POP) and chose a vaginal support device (VSD) after discussing the various options. Different types and sizes were tried, a Gellhorn pessary was inserted, and the woman was comfortable and able to retain it. The woman was advised to attend follow-up after 3 months. Unfortunately, she did not. She presented complaining of the passage of minimal feculent vaginal discharge 5 months after insertion. A pelvic examination was performed and showed a rectovaginal fistula (RVF). Conservative management was chosen. After 2 months, the RVF healed completely. VSDs are commonly used in the management of POP and very rarely lead to the development of RVF, mostly in neglected cases. While surgery is most often used to treat RVF, conservative management is very rarely adopted and may be considered in selected cases.
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Tuma F, McKeown DG, Al-Wahab Z. Rectovaginal fistula. Treasure Island, FL, USA: StatPearls; 2024.
Torbey MJ. Large rectovaginal fistula due to a cube pessary despite routine follow‐up; but what is ‘routine’? J Obstet Gynaecol Res 2014;40:2162-5. DOI: https://doi.org/10.1111/jog.12476
Oliver R, Thakar R, Sultan AH. The history and usage of the vaginal pessary: a review. Eur J Obstet Gynecol Reprod Biol 2011;156:125-30. DOI: https://doi.org/10.1016/j.ejogrb.2010.12.039
Gordon GH, Dolnicek TF, Malviya VK. A problematic peril of pessaries: the rare case of rectovaginal fistulas resulting from pessary use. J Clin Gynecol Obstet 2015;4:193-6. DOI: https://doi.org/10.14740/jcgo308w
Richter LA, Bradley SE, Desale S, Richter HE, et al. Association of pelvic organ prolapse quantification examination D point with uterosacral ligament suspension outcomes: the “OPTIMAL” D point. Int Urogynecol J 2021;32:2179-84. DOI: https://doi.org/10.1007/s00192-021-04687-0
Dabic S, Sze C, Sansone S, Chughtai B. Rare complications of pessary use: a systematic review of case reports. BJUI Compass 2022;3:415-23. DOI: https://doi.org/10.1002/bco2.174
Mendelson J, Grigorescu B, Quinn C, Lazarou G. Pessaries and rectovaginal fistulae: consequences of delayed clinical follow-up in the Covid-19 pandemic. Int Urogynecol J 2021;32:2353-6. DOI: https://doi.org/10.1007/s00192-021-04926-4
Noori IF. Rectovaginal fistulas, outcomes of various surgical repair and predictive factors of healing success. A retrospective cohort study of 40 cases. Int J Surg Open 2021;32:100335. DOI: https://doi.org/10.1016/j.ijso.2021.100335
Oakley SH, Brown HW, Yurteri-Kaplan L, et al. Practice patterns regarding management of rectovaginal fistulae: a multicenter review from the fellows’ pelvic research network. Female Pelvic Med Reconstr Surg 2015;21:123-8. DOI: https://doi.org/10.1097/SPV.0000000000000162
Cichowski S, Rogers RG. Nonsurgical management of a rectovaginal fistula caused by a gellhorn pessary. Obstet Gynecol 2013;122:446-9. DOI: https://doi.org/10.1097/AOG.0b013e31828aec98
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Conservative management of a rectovaginal fistula caused by a Gellhorn pessary. A case report. (2024). Urogynaecologia, 36(1). https://doi.org/10.4081/uij.2024.341
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