A curious cause of pseudo-haematuria: a neglected vaginal pessary.

Cabral Ribeiro J, Leite C. BMJ Case Rep 2017. doi:10.1136/bcr-2017-219690 DESCRIPTION Vaginal pessaries represent a valid therapeutic option for the management of female pelvic organ prolapse in elderly women with significant comorbidities. Although leading to good functional and quality of life outcomes, when neglected, they can cause significant and severe complications. An 87-year-old woman semidependent and uncooperative due to progressive Alzheimer's dementia, who has lived in a nursing home for the last 5 years, presented to our outpatient clinic for ‘intermittent hematuria’. She carried a pelvic ultrasound documenting a ‘polypoid formation with 23 mm on the posterior bladder wall suggesting a bladder tumour’. The blood loss had been detected intermittently in the diaper that she uses for hygienic purposes. There were no analytical abnormalities except for leucoerythrocyturia with positive Escherichia coli urine culture. The hypothesis of a urothelial lesion led to the scheduling of a cystoscopy under anaesthesia and an abdominopelvic CT scan. The abdominopelvic CT scan documented ‘a hyper dense linear formation, superior to the vaginal dome’ (figure 1). After observing the images, we suspected an intravaginal foreign body and performed the coronal CT scan reconstruction. The hyperdense retrovesical formation corresponds to an intravaginal ring shaped structure, consistent with a pessary (figure 2). We performed the cystoscopy under anaesthesia and saw a globally inflammatory bladder with a bulbous pattern, but without tumour lesions. A bladder biopsy revealed erosive cystitis. The procedure was completed with a vaginal examination that confirmed the presence of a pessary intimately adhering to the vaginal wall with an intense inflammatory reaction. Its removal triggered abundant vaginal bleeding. A curious cause of pseudo-haematuria: a neglected vaginal pessary Jorge Cabral Ribeiro, Carolina Leite Images in...