Vaginal pessaries are a simple and effective conservative treatment for pelvic organ prolapse. However, neglected devices can result in rare but serious complications, including incarceration and fistula formation. A woman in her early 30s with a history of uterine prolapse presented with 4 months of discomfort, lower abdominal pain and dyspareunia. She had a ring pessary inserted 1 year earlier, which had not been replaced or maintained. Examination revealed the pessary incarcerated in the posterior fornix with mucosal overgrowth. Histopathology excluded malignancy, routine tests were normal and MRI confirmed pessary incarceration without bladder or rectal involvement. The pessary was removed surgically under general anaesthesia following a mucosal incision. Recovery was uneventful, and at the 2-week follow-up, the patient was asymptomatic with complete healing. This case highlights the importance of follow-up in pessary users, as neglected devices may cause significant morbidity even in younger women.
Sinha et al. (Thu,) studied this question.