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Photograph showing a dead cricket found on cutting the gross specimen of uterus within the uterine cavity.
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... A seventy-year-old grand multipara lady came to the gynecology OPD with complaints of something com- ing out of the vagina since 6 years and difficulty in passing urine and stools with complaint of occasional blood stained discharge for the last 4 months. She had all full-term vaginal deliveries at home which were unsuper- vised. Local examination showed cervix lying around 3 inches outside the introitus with cystocele and rectocele. Overlying mucosa was dry and keratinised. There was no evidence of decubitus ulcer. Palpation revealed atrophic uterus with procidentia. The patient was investigated thoroughly and taken up for vaginal hysterectomy. The surgery was uneventful. On cut section the uterus showed presence of a dead cricket inside the uterine cav- ity with otherwise normal appearing atrophic uterus (Figure 3). The patient was discharged after completing an- tibiotic course in satisfactory ...
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... Very often in postmenopausal women neglected ring pessaries were removed after many years of insertion. Pushpalata et al. [8] reported the removal of front part of a flash light in a nullipara as a result of sexual assault and surprisingly found a dead cricket inside the uterus of a postmenopausal woman after vaginal hysterectomy. An unusual presentation of vesicovaginal fistula happened in an 18 years female who had intentionally inserted a hairspray can for sexual gratification and forgot to remove its cover [9] . ...
... [5][6][7][8] The use of pessaries is common; more than 85% of gynecologists 9 and nearly 98% of urogynecologists prescribe them. 10 They provide anatomic support and can be used as a treatment of choice or in those who decline surgery (e.g., women who plan future childbearing, require temporary relief of prolapse while waiting for surgery or during pregnancy, or do not want surgical repair 11,12 ). ...
Pessary use is the preferred non-surgical treatment option for female pelvic organ prolapse. As pessaries can be used chronically to alter pelvic floor anatomy, consideration of short-and long-term complications is important in patient management. We systematically reviewed articles describing the complications of pessary use to determine frequency and severity.
A systematic search via MEDLINE and PubMed using the key terms "complications," "pessary," "pelvic organ prolapse," "side effects" was conducted for the years 1952 to 2014 inclusively. Selected articles cited in the publications identified were also considered. Only full-text material published in English was reviewed. All pessary-related complications described were collated; overall frequency within case reports and case series were calculated and severity was graded using the Clavien-Dindo classification.
In total, 61 articles met the inclusion criteria. The most common complications reported were vaginal discharge/vaginitis, erosion, and bleeding. Complications were related to pessary shape and material, and duration in situ. Clavien-Dindo classification of complication severity found that all 5 grade levels were attributed to pessary use; serious grade 4 and 5 complications included cancer, adjacent organ fistula and death.
There are few detailed reports of complications of pessary use relative to the estimated frequency of pessary use worldwide. Prospective studies documenting complications by shape, material, and size, and objectively classifying complication severity are required. As serious grade 4 and 5 complications of pessary use occur, further development of clinical follow-up guidelines for long-term pessary users is justified.
A74-year old unmarried female presents with the chief complaint of a stinking smell at the pelvic region which isrecognized by her relative and brings her to the hospital. She denied inserting any foreign body into vagina. On examination,she is healthy, no fever, heart and lungs appear normal. No abnormal palpable abdominal mass except stinking smell atthe pelvic region, on pelvic examination there is matted calcified foreign body in vaginal canal and broken salts bar (inhalantbar) (see arrow Fig A), however the residual foreign body remains in the vaginal canal because it could not evacuate all of thematerials. A CT of lower abdomen with and without and IV and contrast enhancement is performed. The images of CT oncoronal and sagittal sections reveal large rounded calcified FB in the uterine cavity measuring attenuation 832-1054 HounsfieldUnits (HU), with rod like appearance hypoattenuation in the center. A salt bar was removed before this picture taken (see arrowsFig C-D). She underwent a total hysterectomy (Fig B). It shows a salts bar embedded in a calcified foreign body. The patientrecovers eventually after the operation without any complication.
