Pennesi Christine M, Kenney Brian, Thakkar Rajan, Ching Christina, Hewitt Geri, McCracken Katherine
Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.
Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.
J Pediatr Adolesc Gynecol. 2018 Dec;31(6):640-643. doi: 10.1016/j.jpag.2018.07.004. Epub 2018 Jul 21.
Heavy, prolonged menstrual bleeding is common in adolescents and results from a variety of etiologies.
A 13-year-old, virginal girl was referred for prolonged, heavy vaginal bleeding despite combined oral contraceptive use and elected management with a levonorgestrel intrauterine device. A preprocedure exam revealed a plastic foreign body embedded in the posterior vaginal fornix, however, attempted removal in the office was unsuccessful. Subsequent computed tomography imaging of the pelvis revealed a vaginal foreign body, complex adnexal mass, and hydroureter. The patient underwent exam under anesthesia and diagnostic laparoscopy, but required conversion to exploratory laparotomy for removal of a foreign body because of vaginal perforation abutting the rectum.
Foreign bodies not easily removed in the outpatient setting should be considered for surgical removal with consideration of preoperative multidisciplinary coordination when imaging reveals intra-abdominal pathology, such as tubo-ovarian abscess and hydroureter.
月经过多、经期延长在青少年中很常见，其病因多种多样。
一名13岁的未婚女孩尽管使用了复方口服避孕药，但仍出现经期延长、阴道大量出血，遂选择使用左炔诺孕酮宫内节育器进行治疗。术前检查发现阴道后穹窿内嵌有一个塑料异物，然而，在诊室尝试取出未成功。随后的骨盆计算机断层扫描成像显示有阴道异物、附件复杂包块和输尿管积水。患者接受了麻醉下检查和诊断性腹腔镜检查，但由于阴道穿孔靠近直肠，需要转为剖腹探查以取出异物。
当影像学检查显示存在腹腔内病变，如输卵管卵巢脓肿和输尿管积水时，如果异物在门诊环境中不易取出，应考虑手术取出，并考虑术前多学科协作。
