title: Irreducible procidentia due to multiple bladder calculi mimicking impacted faecal mass.
abstract: A case of massive irreducible procidentia with a hard palpable mass in the anterior vaginal wall mimicking an impacted faecal mass in a 57-year-old multiparous, post-menopausal woman is reported. Inability to walk, constipation and urinary incontinence were her primary complaints. Routine CT of the abdomen and pelvis excluded intestinal pathology, but failed to reveal multiple vesical calculi as the procidentia was lying outside the imaging zone of the pelvic CT. However, targeted plain X-ray and ultrasound of the prolapsed mass disclosed the existence of multiple vesical calculi. The patient was managed with single-stage laparotomy and vaginal hysterectomy. Hysterectomy permitted the reduction of the prolapse and facilitated extraperitoneal vesicolithotomy. Laparotomy excluded bowel pathology. No reconstructive surgical steps for repair and reconstruction were combined. Currently, the patient is relieved of all symptoms and her asymptomatic stage II vault prolapse is managed conservatively.
authors.affiliation: Department of Urogynaecology, Institute of Social Obstetrics and Kasturba Gandhi Hospital, Chennai, India. dr_nrm@sify.com
authors.forename: N
authors.initials: N
authors.lastname: Rajamaheswari
authors.forename: S
authors.initials: S
authors.lastname: Agarwal
authors.forename: S
authors.initials: S
authors.lastname: Krishnan
mesh_terms: D003937:Diagnosis, Differential; D005244:Fecal Impaction / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D007813:Laparotomy; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000209:etiology* / Q000601:surgery; D011859:Radiography; D014463:Ultrasonography; D001744:Urinary Bladder Calculi / Q000150:complications* / Q000000981:diagnostic imaging