title: Rare case of neglected pessary presenting with concealed vaginal hemorrhage.
abstract: BACKGROUND
  Vaginal pessaries are commonly used for management of pelvic organ prolapse. Severe complications can occur in neglected cases.
  
  
  METHODS
  A 91-year old woman with significant comorbidities presented with large concealed vaginal bleeding and history of vaginal pessary placement 14 years before. On examination, an impacted Gellhorn pessary in the vagina was noted with some spotting. Serum blood tests revealed severe anemia and renal insufficiency. An abdominal and pelvic computed tomographic scan confirmed a Gellhorn pessary and a large vaginal accumulation of blood superior to impaction. The pessary was surgically removed vaginally under anesthesia. Recovery was uneventful, and the patient was discharged 1 week later.
  
  
  CONCLUSIONS
  Our case underlines the need of follow-up and compliance after pessary placement for early detection of complications.
authors.affiliation: From the *Department of Obstetrics, Gynecology, and Women's Health, Winthrop University Hospital, †Urogynecology and Reconstructive Pelvic Surgery, Winthrop University Hospital; and ‡Department of Obstetrics, Gynecology and Women's Health, Stony Brook University Hospital.
authors.forename: Maria
authors.initials: M
authors.lastname: Andrikopoulou
authors.forename: George
authors.initials: G
authors.lastname: Lazarou
mesh_terms: D000369:Aged, 80 and over; D020878:Device Removal; D005260:Female; D005547:Foreign Bodies / Q000150:complications*; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D010349:Patient Compliance; D056887:Pelvic Organ Prolapse / Q000628:therapy; D010570:Pessaries / Q000009:adverse effects*; D011859:Radiography; D014592:Uterine Hemorrhage / Q000209:etiology*