title: Impaction after partial expulsion of a neglected pessary.
abstract: BACKGROUND
  Vaginal pessaries are effective for treating pelvic organ prolapse, and severe complications are rare. We describe an exceptional case of pessary impaction with partial expulsion.
  
  
  METHODS
  An elderly woman had mild discomfort from a pessary protruding through the perineal skin. The pessary was cut, removed, and the perineum healed uneventfully.
  
  
  CONCLUSIONS
  Negligence of vaginal pessaries may result in migration to the bladder or to the rectum. This case of perineal expulsion was eventually easily treated. Although no evidence-based guidelines for pessary care exist, this rare manifestation suggests the need for follow-up on a regular basis.
authors.affiliation: From the Departments of Obstetrics and Gynecology of the Regionaal Ziekenhuis Tienen, Belgium, and the University Hospitals K.U. Leuven, Leuven, Belgium.
authors.forename: Judith
authors.initials: J
authors.lastname: Berger
authors.forename: Thierry
authors.initials: T
authors.lastname: Van den Bosch
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
mesh_terms: D000369:Aged, 80 and over; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004868:Equipment Failure; D005260:Female; D006801:Humans; D010349:Patient Compliance; D010502:Perineum; D010570:Pessaries / Q000009:adverse effects*; D014596:Uterine Prolapse / Q000601:surgery*