Multiple foreign bodies of long duration in adult vagina

Published Date: 19th July 2016

Publication Authors: Dhannapuneni JS, , Srivastava N

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Introduction 

Foreign bodies of long duration are not unusual in adult vagina. Several published in literature involve children, especially pre-pubertal girls often related to curiosity. Variety of objects have been retrieved ranging from tampons, sex toys, forgotten pessaries, pens, pencil tops, bottles, aerosol caps, fruits, vegetables and packets containing illicit drugs. Although retrieval can be straightforward, they can be challenging at times when clear history is uncertain, chronic or presentation is late. The sequel of such foreign bodies includes excessive vaginal discharge, pelvic infection, formation of recto-vaginal, vesico-vaginal fistula and migration into retroperitoneal space. Most reported have described identification and retrieval of single foreign bodies. We present here a case of multiple objects being retrieved from the vagina of a young adult woman.

Case  

An 18-year-old nulli-gravida presented to accident and emergency with 3 day history of left sided abdominal pain preceded by yellowish offensive vaginal discharge. On admission she was septic with a temperature of 38.2 and a pulse rate of 152. Pregnancy test was negative even though she was amenorrhoeic. She had progesterone implant in situ. She reported her boyfriend complained of feeling something sharp at intercourse 3 weeks prior to presentation. Cardiovascular and pulmonary examination was normal. Abdominal examination was tender on the left lower side of the abdomen and in the umbilical area. There was no guarding or peritonism. Speculum examination revealed a plastic tube-like structure at the top of vagina along with copious yellowish offensive discharge. Attempt at removal with Spencer wells was difficult as it seemed embedded in the cervical and vaginal tissues and caused significant pain. Blood test results showed raised white cell, neutrophil count and C-reactive protein levels. She was commenced on iv cefuroxime and metronidazole and oral doxycycline. Urgent investigation with pelvic USS and MRI of the lower abdomen confirmed foreign objects in the pelvis. The objects (displaced) were retrieved from the vagina under general anaesthesia.

Conclusion 

Although foreign bodies are not uncommon in preadult vagina, multiple foreign bodies in vagina are not unusual in adult vagina. We like to use this case to highlight possibilities of finding multiple foreign bodies in the adult vagina, often inserted by the individual for various reasons.

Dhannapuneni JS; Srivastava N; Nwosu EC. (2015).  Multiple foreign bodies of long duration in adult vagina . BJOG: An International Journal of Obstetrics and Gynaecology. 122 (Suppl S1), 74

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