title: Neglected pessary causing a rectovaginal fistula: a case report.
abstract: BACKGROUND
  Pessaries, properly maintained, have been shown to be safe for long-term care of symptomatic vaginal prolapse. Complications from neglected pessaries include impaction, erosion and fistula formation. Vesicovaginal fistulas have been described, but literature reports of rectovaginal fistulas are scarce.
  
  
  METHODS
  A 70-year-old woman, referred for pessary management, was found to have an impacted pessary that could not be removed due to pain. Examination under anesthesia revealed a Gellhorn pessary in the lumen of the rectum. It was removed transanally, leaving a large rectovaginal fistula. The patient was scheduled for reparative surgery in conjunction with colorectal surgery, but she cancelled the day before.
  
  
  CONCLUSIONS
  For patients with a rectovaginal fistula resulting from an impacted vaginal pessary, a 2-stage procedure is required. The first stage, done under anesthesia, includes removal of the pessary and an examination to assess the size and location of the fistula. The second stage is operative management of the rectovaginal fistula, preceded by adequate bowel preparation. The clinician must stress proper pessary maintenance in order to avoid the serious consequences of a neglected pessary.
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10467, USA. hoppowers@aol.com
authors.forename: Kenneth
authors.initials: K
authors.lastname: Powers
authors.forename: Bogdan
authors.initials: B
authors.lastname: Grigorescu
authors.forename: George
authors.initials: G
authors.lastname: Lazarou
authors.forename: Wilma Markus
authors.initials: WM
authors.lastname: Greston
authors.forename: Thomas
authors.initials: T
authors.lastname: Weber
mesh_terms: D000368:Aged; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications*; D006801:Humans; D010570:Pessaries / Q000009:adverse effects*; D012006:Rectovaginal Fistula / Q000209:etiology*; D014596:Uterine Prolapse / Q000628:therapy