E-Posters-10113

10113_Glowacki

Pdf Summary

This case series discusses four cases of rectovaginal fistula formation from the use of space-occupying pessaries. Pessaries are commonly used in the nonsurgical management of pelvic organ prolapse in the elderly, and serious complications are rare. However, there have been ten reported cases of rectovaginal fistula formation from pessary use, which were usually managed with surgical repair.<br /><br />The four cases presented in this series involve elderly patients who developed rectovaginal fistulas after using space-occupying pessaries. Three of the cases resulted from Gellhorn pessary use and one from a cube pessary. The patients' ages ranged from 81 to 89 years. Initially, all four patients were managed with vaginal estrogen, which resulted in a decrease in fistula size. However, surgery was declined in three of the cases. Eventually, all four cases underwent successful repair of the fistula, with one case also requiring repair of stage IV prolapse.<br /><br />The authors conclude that serious complications from space-occupying pessaries in the elderly may be more common than reported. They recommend the use of vaginal estrogen along with interval surgical management to maximize the closure of the fistula and improve surgical outcomes. They also note that concurrent repair of rectovaginal fistula and stage IV prolapse can be successful. Conservative management of rectovaginal fistula may be appropriate in the elderly.<br /><br />The case summaries include details such as the age of the patients, the type of pessary used, the management approach, and the outcomes. In these cases, vaginal estrogen was started, leading to a decrease in fistula size in all four patients. Surgery was declined in some cases but eventually performed successfully in others. The authors emphasize the importance of regular follow-up and early detection of complications related to pessary use in the elderly.

Keywords

rectovaginal fistula

space-occupying pessaries

pelvic organ prolapse

elderly patients

Gellhorn pessary

cube pessary

vaginal estrogen

surgical repair

stage IV prolapse

conservative management