School of Medicine, University of Leeds School of Medicine, Leeds, UK
University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.
BMJ Case Rep. 2024 Apr 2;17(4):e257233. doi: 10.1136/bcr-2023-257233.
Vaginal pessaries are widely considered to be a safe and effective non-surgical management option for women with pelvic organ prolapse. Complications may occur, and are more frequent with improper care and certain device designs and materials. It is imperative to provide information to patients about potential complications. We present the case of a woman in her 70s who presented to the Emergency Department with increasing groin and abdominal pain following a vaginal pessary insertion 2 days prior for grade 3 vaginal vault prolapse. On presentation, her abdomen was markedly distended with guarding. Laboratory investigations showed a significant acute kidney injury with a metabolic acidosis. An initial non-contrast CT showed fluid and inflammatory changes surrounding the bladder, and bladder perforation was suspected. A subsequent CT cystogram showed extravasation of contrast from the bladder into the peritoneal cavity, in keeping with an intraperitoneal bladder rupture. The patient underwent an emergency bladder repair in theatre.
阴道子宫托被广泛认为是治疗盆腔器官脱垂的安全有效的非手术管理选择。可能会出现并发症，并且如果护理不当以及使用某些装置设计和材料，并发症会更加频繁。向患者提供有关潜在并发症的信息至关重要。我们介绍了一位 70 多岁的女性患者，她在阴道托两天前因 3 级阴道穹窿脱垂插入阴道后，出现腹股沟和腹部疼痛逐渐加重，随后到急诊科就诊。就诊时，她的腹部明显膨隆，有明显的压痛。实验室检查显示严重的急性肾损伤合并代谢性酸中毒。初始的非增强 CT 显示膀胱周围有液体和炎症改变，怀疑有膀胱穿孔。随后的 CT 膀胱造影显示造影剂从膀胱漏入腹腔，符合腹腔内膀胱破裂。患者在手术室接受了紧急膀胱修复术。
