Vaginal Foreign Body Research Articles

Ultrasonography in Detection of Vaginal Foreign Bodies in Girls: A Retrospective Study

Study ObjectiveIn this study we investigated the sonographic features of vaginal foreign bodies in girls and the diagnostic role of combined transperineal and transabdominal ultrasonography in the detection of vaginal foreign bodies in this population. Design, Setting, Participants, Interventions, and Main Outcome MeasuresA retrospective review of the records of 249 girls seen in the outpatient pediatric and adolescent gynecology clinic of our hospital and referred to our department for sonographic evaluation of suspected vaginal foreign bodies between 2013 and 2016 was performed. All patients were transperineally and transabdominally scanned using an ultrasound machine with 3-MHz and 7.5-MHz transducers. The sonographic features of the detected foreign bodies were recorded and reported. All patients also underwent pelvic radiography. The presence of foreign bodies was confirmed using vaginoscopy. ResultsTwo hundred forty-nine patients were included in this study, and vaginal foreign bodies were detected in 181 patients. Vaginal foreign bodies often present in girls aged from 2 to 12 years old. The most common vaginal foreign bodies were toilet paper, beads, small parts of toys, cap of water color brush, and crayons. The overall sensitivity, specificity, positive and negative predictive values of transperineal/transabdominal sonography in the diagnosis of vaginal foreign bodies were 81%, 53%, 82%, and 51%, respectively. The sensitivity, specificity, and positive and negative predictive values of transabdominal sonography were 33%, 49%, 63%, and 21%, respectively. The sensitivity, specificity, and positive and negative predictive values of transperineal sonography were 64%, 49%, 77%, and 33%, respectively. Abnormal findings were detected using x-ray in only 43 of the 181 cases (23.7%). The sensitivity, specificity, and positive and negative predictive values of x-ray were 24%, 91%, 88%, and 31%, respectively. The size of the foreign bodies ranged from 2 mm to 35 mm. For foreign bodies larger than 5 mm, the rate of sonographic accuracy reached 100%. For foreign bodies smaller than 5 mm, 32 false positive results, and 34 false negative results were identified. One hundred thirty-nine of 181 foreign bodies were less than 2 cm from the vaginal orifice (77%). All foreign bodies were hyperechoic compared with adjacent tissues. Some vaginal foreign bodies had characteristic echo patterns. With the exception of 1 patient with a detained AAA battery that caused vaginal ulceration, the other patients had a full recovery. ConclusionVaginal foreign bodies were hyperechoic compared with adjacent tissues and often had characteristic echo patterns. The use of combined transperineal and transabdominal ultrasonography might be helpful in diagnosing foreign bodies, especially when the size of the foreign body is larger than 5 mm. Therefore, ultrasonography might be preferred for the initial evaluation of suspected vaginal foreign bodies, because it is a noninvasive, radiation-free, and inexpensive technique.

Re-treatments of recurrence after pelvic floor repair surgery

Objective: To analyze re-treatments of recurrence after the pelvic floor repair surgery. Methods: The protocol and the effect of re-treatments were investigated by reviewing and analyzing the clinical data of 81 recurrent patients (grade Ⅱ and above), who had received the pelvic floor repair surgery from January 2011 to January 2016. Pelvic organ prolapse quantitation system (POP-Q) and two questionnaires about quality of life [pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7)] were used to evaluate objective and subjective efficacy, respectively. Results: Among 81 recurrent patients who were followed up for a median of 35 months (10- 69 months), 78 cases (with prolapse up to grade Ⅲ or Ⅳ) were treated by surgical operation with both objective cure rate and subjective satisfaction being 100% (78/78); 3 cases (with grade Ⅱ prolapse) were treated by pelvic floor electrical stimulation biofeedback, and 1 case among the three cases had the vaginal foreign body sensation, the subjective satisfaction was 2/3. The methods of surgical operation for the 78 recurrent patients included: total pelvic floor reconstructive surgery (55 cases; 3 of which involve trachelectomy), anterior pelvic reconstructive surgery (2 cases), posterior pelvic reconstructive surgery (3 cases), Y-mesh sacral colpopexy (2 cases), colpocleisis (11 cases), vaginal hysterectomy combined posterior fornix forming (3 cases), and vaginal hysterectomy combined posterior pelvic reconstructive surgery(2 cases). Conclusion: The extent of recurrence, the recurrent site and complications must be carefully considered and evaluated for re-treatments of recurrence after pelvic floor repair surgery, and then an appropriately individualized re-treatment protocol could be designed for each of the patients.

Unusual Cause of Pediatric Vaginal Bleeding: Infantile Capillary Hemangioma of the Cervix

Infantile hemangiomas (IH) are the most common soft tissue tumors of infants and children which characteristically spontaneously resolve by 7-10 years of age. IH generally require no intervention, but rarely can cause disfiguration, functional impairment, bleeding or infection. Here we present a unique case of cervical infantile hemangioma in a 6 yo who presented with vaginal bleeding requiring transfusion. Patient is a 6 year 10 month-old female with history of unexplained intermittent vaginal bleeding since 6 months of age. On current presentation, she presented to an outside hospital with acute vaginal bleeding, accompanied by a 5 unit drop in Hgb over 24 hours, requiring transfusion. Previous evaluation by Pediatric and Adolescent Gynecology service at 28 months with vaginoscopy revealed normal anatomy but evidence of vaginitis and cervicitis, which was treated with topical estrogen. She was subsequently followed by pediatric endocrinology, with findings of no evidence of precocious puberty, and labs consistent with prepubertal state. Upon presentation to the outside hospital requiring transfusion, she had a normal pelvic ultrasound showing a prepubertal uterus and ovaries. She was transferred to our medical center for ongoing management where she underwent an urgent exam under anesthesia and repeat vaginoscopy which revealed a <1 cm cervical raised papule that was biopsied. Hemostasis was achieved with vaginal packing which was uneventfully removed POD 1. Pathology was consistent with infantile capillary hemangioma, with capillary vascular proliferation and positive staining for GLUT-1. Follow up MRI with contrast did not show evidence of a vascular lesion or pelvic mass. The differential diagnoses for vaginal bleeding in the prepubertal child include vaginal foreign body, trauma, neoplasm, precocious puberty, and vascular malformations. Only a single case report of infantile hemangioma of the cervix has previously been reported in the literature. In non-cutaneous cases, diagnosis must rely on imaging and pathology. MRI is used to delineate the location and extent of IH, and differentiate it from other high-flow vascular lesions such as arteriovenous malformations. In this case, however, the lesion could not be appreciated on imaging, likely due to its small size. Pathological assessment was crucial to our diagnosis. The cervical biopsies taken at time of vaginoscopy demonstrated capillary vascular proliferation, GLUT-1 and WT-1 positivity, but PROX-1 negativity. GLUT-1 is a sensitive and specific marker for both proliferating and involuting IH. It is not found in other vascular neoplasms or malformations. Profuse bleeding is a rare complication of IH and has been most noted in the hemangiomas of the GI tract. IH in GI system can be treated with medication corticosteroids with or without propranolol, or may require surgical resection. Follow up treatment for this patient will consist of a 6 month trial of propranolol with repeat vaginoscopy and possible excision. In the future, physicians should consider infantile hemangioma of the vagina or cervix as part of the differential diagnosis in patients presenting with prepubertal bleeding.

Urethrovaginal Fistula Following Vaginal Prolapse of a Pedunculated Uterine Myoma: A Case Report

Urethrovaginal fistulas are usually secondary to vaginal foreign body or to gynaecological surgery. The authors hereby present a case of an urethrovaginal fistula that occurred in a woman with vaginal prolapse of a pedunculated myoma. The fistula was successfully repaired. The authors recommend the urgent management of a vaginally prolapsed uterine fibroid to reduce the risk of urethrovaginal fistula formation.

Spectrum of vaginal foreign body in children: A report of two cases

An extraordinary type of foreign body (FB) may be found in the female external genitalia, especially in children. Intravaginal FB, retained for long duration, can produce diagnostic dilemma. Vaginal bleeding as the result of a leech bite is extremely rare although reported. We report two cases of vaginal FB (intravaginal Scotch-Brite in a 5-year-old girl and leech in the vagina in a 7-year-old girl).

Prepubertal vaginal discharge: Vaginoscopy to rule out foreign body.

Medical records of all prepubertal patients who underwent vaginoscopy to rule out vaginal foreign body between 2004 and 2013 were reviewed retrospectively. All patients were evaluated by pediatricians prior to surgical consultation. Vaginoscopy is performed in the operating room under general anesthesia. During the study period, 20 girls with persistent vaginal discharge with a mean age of 6.8 years (1-13 years) underwent vaginoscopy to rule out vaginal foreign body. Six patients had bloody vaginal discharge and 4 had recurrent vaginal bleeding lasting for more than one month. Ten patients had purulent vaginal discharge lasting for 1-7 months. None of vaginal cultures revealed pathological bacteria or candida species. Preoperative imaging techniques revealed vaginal foreign body in one patient only. Vaginoscopy demonstrated vaginal foreign bodies in four patients. Foreign bodies were grass inflorescence, safety pin and undefined brownish particles (n=2), which may be pieces of toilet paper or feces. There was no complication related to vaginoscopy and removal of foreign body. Hymen integrity was preserved in all patients. Persistent or recurrent vaginal discharge in prepubertal girls should raise the suspect of vaginal foreign body. Continuous flow vaginoscopy is mandatory to detect and remove any vaginal foreign body. Early diagnosis would prevent complications secondary to long-standing foreign bodies.

A vaginal foreign body presenting as vesico-vaginal fistulae in a pre-pubertal girl: A case report and review of the literature

Abstract Background: A neglected foreign body in a vagina leading to vesico-vaginal fistulae in young girls is a very rare presentation. As such, it poses significant therapeutic challenges in its

Vaginitis. Ampliando el espectro diagnóstico

El diagnóstico de vaginitis usualmente se asocia a vaginosis bacteriana, Trichomonas vaginalis o Cándida albicans. Sin embargo, no son los únicos responsables de flujo vaginal, el síntoma más frecuente de vaginitis. En esta comunicación se presenta otras causas menos frecuente de flujo vaginal. Los casos de vaginitis en la niña son generalmente secundarios a problemas dermatológicos en la vulva. La presencia de flujo sanguinolento con mal olor puede ser por un cuerpo extraño en la vagina. Las bacterias que producen vaginitis con más frecuencia en las niñas son Hemophylus influenzae, estreptococo grupo A y Escherichia coli. El tratamiento debe ser dirigido a la causa del problema. En la mujer pre y posmenopáusica, la presencia de flujo puede ser por vaginitis atrófica o vaginitis inflamatoria descamativa. Con relación al tratamiento, en el primer caso se recomienda el uso de estrógenos tópicos o sistémicos y en el segundo el uso de clindamicina al 2% en crema vaginal. Una causa de flujo puede ser la cervicitis, siendo los agentes patógenos más frecuentes en esta localización el Chlamydia trachomatis y el Neisseria gonorrhoeae. El tratamiento recomendado en estos casos sería azitromicina o doxicilina y ceftriaxona o ciprofloxacino, respectivamente.

Vaginoscopia en niñas prepúberes

Objetivo: Conocer las patologías ginecológicas en niñas prepúberes, que requirieron uso del vaginoscopio para su diagnóstico. Diseño: Estudio descriptivo, retrospectivo y transversal. Institución: Servicio de Ginecología, Instituto Nacional de Salud del Niño, Lima, Perú. Participantes: Niñas prepúberes. Intervenciones: Durante el periodo 2000-2007, se evaluó 32 niñas prepúberes en las cuales se realizó vaginoscopia para el diagnóstico o facilitar el manejo de patologías ginecológicas. Principales medidas de resultados: Correlación de vaginoscopia y diagnósticos de patología ginecológica. Resultados: Las patologías encontradas con más frecuencia fueron la vulvovaginitis crónica, en 23 casos (71,9%), sangrado vaginal en 3 casos (9,4%), fístula rectovaginal en 2 (6,3%), maltrato infantil, tumoración vaginal, cloaca baja y displasia cervical. Los diagnósticos postoperatorios fueron vulvovaginitis crónica (40,6%), vaginitis más cervicitis (34,4%), tabique vaginal más fístula rectovaginal, vulvovaginitis más secuela de traumatismo genital, tumor de células germinales, sarcoma botrioides, pólipo vaginal, cuerpo extraño en vagina, displasia cervical y vagina normal. El tiempo operatorio promedio fue de 23 minutos y el tiempo de anestesia general 39 minutos; la mayoría de pacientes fue dada de alta en buenas condiciones y solo 3 permanecieron hospitalizadas (9,4%). Conclusiones: La vaginoscopia bajo anestesia en niñas prepúberes permitió el diagnóstico de diferentes patologías ginecológicas de manera segura.

Etiological analysis of vaginal bleeding in girls

Objective To investigate the etiological factors for abnormal vaginal bleeding in girls. Methods Data of 65 female children aged from 3 months and 10 years old with abnormal vaginal bleeding, who were treated in Department of Endocrinology, Wuhan Children's Hospital from March 2009 to October 2013 were collected by using medical records and follow-ups.By means of pelvic ultrasound, bone age assessment, hysteroscope, hormone level and genetic testing, the causes of the disease were analyzed. Results Of 65 patients, 37 cases had breast developed, 21 cases had nipple, areola and vulva pigmentation increased, 16 cases with genital secretions increasing and odor, the height growth in 21 cases accelerated, abdominal pain was presented in 5 cases, and 6 cases had skin milk coffee spots.The leading etiological factors for vaginal hemorrhage in these girls were sexual precocity.The peripheral precocious puberty accounted for the first place(30/65 cases, 46.2%), and followed by the central precocious puberty(20/65 cases, 30.8%). Hyperphlogosis accounted for 12.3%(8/65 cases), vaginal foreign body accounted for 6.2%(6/65 cases), and genital tract tumors accounted for 4.6%(3/65 cases). In the 30 peripheral precocious puberty cases, exogenous precocious puberty accounted for 16.9% (11 cases), 8 cases(12.3%) were of solitary ovarian cyst, 8 cases(12.3%) of McCune-Albright syndrome, and 3 cases of ovarian tumors.In the 20 central precocious puberty cases, idiopathic central precocious puberty accounted for 18.5%(12 cases), 4 cases(6.2%) were of organic disease of central nervous system, and 4 cases(6.2%) of hypothyroidism.Of 65 children, 12 cases lost follow-up and 1 case abandoned treatment.The rests received appropriate treatment according to different causes, and the vaginal bleeding were effectively controlled after 3 months to 2.5 years of follow-ups without recurrence of bleeding.But there were 2 cases of isolated ovarian cyst and 3 cases of McCune-Albright syndrome turned into central precocious puberty. Conclusions Endocrine diseases are the common factors for children's vaginal bleeding.Neoplasm is not rare in girl's abnormal vaginal hemorrhage. Key words: Uterine hemorrhage; Etiology; Puberty precocious; Child

Vesicovaginal fistula. Incidence, etiology and phenomenology in Germany

Vesicovaginal fistulae are much more common in developing countries along the equatorial fistula belt than in industrialized countries. However, although the classical obstetric fistula caused by lack of medical support through pregnancy and delivery in adolescent primiparae has almost vanished in Germany, we are now facing new and predominantly iatrogenic variants. Increasing frequency of gynecological surgery as well as pelvic radiation, forgotten vaginal foreign bodies, or uninhibited cancer growth are the modern causes for vesicovaginal fistula in elderly patients. Comorbidities and genital atrophy impair surgical therapy in view of a limited success rate of conservative transient transurethral catheterization. Diagnostics should start early and should be initially limited to vaginal inspection, cystourethroscopy, and the blue dye test. Radiological investigations including CT and MRI are only indicated in patients suspicious for ureterovaginal fistula or with inconclusive findings or malignant fistula. The surgical armamentarium comprises vaginal, abdominal, and combined approaches, which all underlie basic principles of fistula repair: protection of the ureteral orifices, complete excision of the fistula canal, accurate separation of the organs connected to the fistula, sufficient tissue mobilization for tension-free suturing, interposition of padding material for prevention of recurrency. Depending on the degree of sphincter damage, stress urinary incontinence might persist despite successful fistula repair, requiring further incontinence surgery or ultimate urinary diversion in recurrent cases that are hopeless.

Retained Vaginal Foreign Body in Minimally Invasive Gynecological Surgeries

Background: Retention of a surgical object in a patient’s body is a preventable human error that is rare but can cause serious clinical complications, lead to malpractice lawsuits, and be a devastating event both for the patient and the care provider. Although the incidence of retained foreign bodies in the abdomen tends to decrease with the rise in minimally invasive surgery, a retained surgical object in the vagina is a possible adverse outcome of which the surgical team should be aware. Cases: We describe 2 cases of minimally invasive surgeries that were complicated by a retained surgical object in the vagina and occurred within 2 consecutive years at the same institution. The first case describes a retained Asepto bulb (Xodus Medical, New Kensington, Pennsylvania) after a robot-assisted total laparoscopic hysterectomy, and the second describes a retained surgical sponge after a laparoscopic ovarian cystectomy. Both patients did well after removal of the foreign body, without major complications. Conclusion: The counting system and radiographic screening for high-risk cases are not reliable methods to prevent retained foreign objects. Communication is always important, and standardization of the language in the operating room is essential. The surgical team should be aware of a retained foreign body as a possible adverse outcome, and specific steps should be taken to ensure that all objects are removed from the patient at the completion of the surgery.

A vaginal fornix foreign body in a bitch: a case report

A six-year-old intact female Lagotto Romagnolo was referred with a two-day history of purulent vulvar discharge associated with fever, lethargy, polyuria, polydipsia and signs of abdominal pain. Abdominal ultrasound revealed a grass awn foreign body in the vaginal fornix. Culture swabs obtained from the vagina revealed the presence of Staphylococcus epidermidis as the preponderant organism. Ovariohysterectomy was performed, and the presence of the grass awn was confirmed. A chronic-active vaginitis was found at histological examination. The dog recovered with resolution of all clinical signs.&amp;nbsp; Differential diagnoses for acute vulvar discharge in bitches should include retention of vaginal foreign bodies. To the authors&amp;rsquo; knowledge, this is the first reported case of a grass awn foreign body in the vaginal fornix of a dog. &amp;nbsp;

An Earring Incidentally Diagnosed and Removed Through Two-Step Vaginoscopy in a Pubertal Virgin Girl With Miliary Tuberculosis

A vaginal foreign body is detected in approximately 4% of pediatric gynecologic outpatient examinations [1]. Vaginoscopy using small-diameter hysteroscopes is a safe, convenient, and efficient diagnostic and therapeutic method in such cases [2,3]. Herein is reported an exceptional case of an earring in the vagina, which was incidentally detected at abdominopelvic radiography in a virgin adolescent girl and removed via 2-step vaginoscopy using miniature instruments.

Retained Vaginal Foreign Body in Minimally Invasive Gynecological Surgeries

Background: Retention of a surgical object in a patient’s body is a preventable human error that is rare but can cause serious clinical complications, lead to malpractice lawsuits, and be a devastating event both for the patient and the care provider. Although the incidence of retained foreign bodies in the abdomen tends to decrease with the rise in minimally invasive surgery, a retained surgical object in the vagina is a possible adverse outcome of which the surgical team should be aware. Cases: We describe 2 cases of minimally invasive surgeries that were complicated by a retained surgical object in the vagina and occurred within 2 consecutive years at the same institution. The first case describes a retained Asepto bulb (Xodus Medical, New Kensington, Pennsylvania) after a robot-assisted total laparoscopic hysterectomy, and the second describes a retained surgical sponge after a laparoscopic ovarian cystectomy. Both patients did well after removal of the foreign body, without major complications. Conclusion: The counting system and radiographic screening for high-risk cases are not reliable methods to prevent retained foreign objects. Communication is always important, and standardization of the language in the operating room is essential. The surgical team should be aware of a retained foreign body as a possible adverse outcome, and specific steps should be taken to ensure that all objects are removed from the patient at the completion of the surgery.

English

Vaginal pessaries still have a role in the management of uterine prolapse, particularly in elderly patients. Foreign body in vagina is common in young children such an event in adults is rare. We present two case of long forgotten vaginal foreign body (pessary) detected 35 and 24 years after its insertion in a 84 and 67 year old lady. Both the patients presented with malodorous and occasional bloody discharge per vaginum. Both of them were suspected for cancer of cervix and were referred to Gynaecological Oncology department. They were found to be having an impacted ring pessary and it was removed with some difficulty. The patients are asymptomatic thereafter. A review of the relevant literature was undertaken and complications associated with vaginal pessaries are reviewed.

Rectorrhagia and Vaginal Discharge Caused by a Vaginal Foreign Body – A Case Report and Review of Literature

An 8-year-old girl was taken to an outpatient clinic of surgery suffering from rectorrhagia and purulent, smelly vaginal discharge. Colonoscopy and biopsy were done before referring and sulfasalazine regime was administrated for probable colitis. The surgeon performed a rigid rectosigmoidoscopy under general anesthesia and no positive evidence was found. Having examined the hymen, it was found to be intact but a purulent discharge was observed. After drying the discharge, a black foreign body was seen in the bottom of the vagina and brought out by a fine forceps. It was a toy's wheel. The patient and her mother both denied foreign body abusing history. It was recommended she go for a psychological consultation. Generally speaking, all young patients suffering from vaginal or rectal bleeding with or without discharge should have their vagina checked for a foreign body. What is recommended in such cases is to undergo sonography or plain radiography before considering invasive or non-invasive procedures for evaluating anal and sigmoid abnormalities. Last but not least, a vaginal irrigation, precise examination of hymen, and posterior fossa can prove very useful for detecting simple vaginal bodies that can lead to various vaginal, rectal and abdominal complications.

Vaginal foreign body: Successful management with vaginoscopy

The etiology of chronic vaginal discharge in children varies and can be seen as infection, sexual abuse, congenital malformations, vulvar skin disease, vaginal neoplasms and a foreign body. A vaginal foreign body is not a common problem in childhood but it should always be considered when a little girl consults a physician with a chronic vaginal discharge problem. We present the diagnosis and treatment management via vaginoscopy applied to a 6 year old girl who complained of a foul smelling vaginal discharge that had been resistant to medical treatment for the last two years.

Abdominal Sonography for Diagnosis of Vaginal Grains in Chinese Children

Grains embedded as vaginal foreign bodies sometime occur in Chinese children. We summarized the sonographic characteristics of vaginal grains in 4 Chinese children and retrospectively analyzed the clinical data. Abdominal sonography can be the first choice for diagnosis of vaginal grains because of its noninvasive nature, high specificity, and low cost.

Vaginal foreign bodies and child sexual abuse: an important consideration.

Vaginal foreign bodies are a complaint occasionally encountered in pediatric clinics and emergency departments, and when pediatric patients present with a vaginal foreign body sexual abuse may not be considered. We describe two children with vaginal foreign bodies who were found to have been sexually abused. Each child had a discharge positive for a sexually transmitted infection despite no disclosure or allegation of abuse. We recommend that all pre-pubertal girls who present with a vaginal foreign body should be considered as possible victims of sexual abuse and should receive a sexual abuse history and testing for sexually transmitted infections.