Guanà Riccardo, Carpino Andrea, Garbagni Giuseppe, Morchio Cecilia, Garofalo Salvatore, Pane Alessandro, Scottoni Federico, Zambaiti Elisa, Perucca Giulia, Madonia Elena, Gennari Fabrizio
Division of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy.
Department of Pediatrics, Ospedale Infantile Regina Margherita, Turin, Piemonte, Italy.
European J Pediatr Surg Rep. 2022 Sep 19;10(1):e135-e140. doi: 10.1055/a-1920-5849. eCollection 2022 Jan.
Acquired vaginal strictures are rare entities in children. As a result, they are generally difficult to manage and tend to recur despite appropriate initial therapy. This case study reports the staged management of vaginal stenosis following the insertion of a button battery. In this case, an 11-year-old girl experienced at 4 years old a battery insertion in the vaginal canal by her neighbor's son, who was 6-year-old at the time. Two weeks from insertion, the parents noted the foreign body discharge spontaneously. The girl had not complained of any symptoms at the time and had been asymptomatic for many years. In November 2020, she came to the emergency department reporting cramping abdominal pain accompanied by mucopurulent discharge. An abdominal ultrasound showed the presence of hematometrocolpos, and a vaginal stenosis dilation under general anesthesia was performed the following day. After 3 weeks, the stenosis was still present, preventing the passage of Hegar number 4. The girl was subjected to a vaginoscopic stenosis resection utilizing a monopolar hook passed through an operative channel. A Bakri catheter filled with 120 mL of water was left in place. After 10 days, the girl was discharged home with the Bakri inserted. Two weeks after discharge, she was reevaluated in the outpatient setting, where the Bakri was removed with no signs of residual stenosis. Acquired vaginal stenosis could be demanding to treat, particularly with the sole conservative approach. A first-line option can be the Hegar dilation. The endoscopic approach can be a second-line, minimally invasive treatment, but long-term outcomes are difficult to predict.
获得性阴道狭窄在儿童中是罕见的情况。因此，它们通常难以处理，并且尽管进行了适当的初始治疗仍倾向于复发。本病例研究报告了纽扣电池插入后阴道狭窄的分期管理。在这个病例中，一名11岁女孩在4岁时被邻居6岁的儿子将电池插入阴道。插入后两周，父母自行注意到有异物排出。当时女孩没有抱怨任何症状，并且多年来一直无症状。2020年11月，她因腹痛伴黏液脓性分泌物到急诊科就诊。腹部超声显示有经血潴留，第二天在全身麻醉下进行了阴道狭窄扩张。3周后，狭窄仍然存在，无法通过4号黑加耳扩张器。该女孩接受了通过手术通道插入单极钩进行的阴道镜下狭窄切除术。留置了一个装有120毫升水的巴克里导管。10天后，女孩带着插入的巴克里导管出院回家。出院两周后，她在门诊接受复查，巴克里导管被取出，没有残余狭窄的迹象。获得性阴道狭窄的治疗可能很棘手，尤其是仅采用保守方法时。一线选择可以是黑加耳扩张。内镜方法可以是二线的微创治疗，但长期结果难以预测。
