INTRODUCTION
Vaginal foreign bodies represent a rare condition characterized by prolonged, malodorous vaginal discharge and bleeding with obscure etiology. Patients may present with nonspecific symptoms such as nausea and abdominal pain alongside these symptoms. Studies regarding vaginal foreign bodies are predominantly in the form of case presentations, with few reports documented on this subject (1, 2).
This case presentation involves an adult patient with cerebral palsy who presented to the emergency department with complaints of nausea and abdominal pain, ultimately diagnosed with a vaginal foreign body on CT scan.
CASE
A 31-year-old female patient with cerebral palsy was brought to our emergency department by her relatives, complaining of nausea and abdominal pain that started in the morning. The patient had visited an outpatient clinic two days prior, where she was examined and discharged with antiemetic medication prescribed. On initial assessment, her Glasgow Coma Scale was normal, vital signs were within normal limits, and she had no fever. Physical examination revealed no guarding or rebound tenderness in the abdomen, and there was no distention noted. A computed tomography (CT) scan of the abdomen revealed a dense appearance approximately 60 mm in diameter in the pelvic region (mass? calculus?)(Image 1, 2 and 3). Abdominal ultrasound reported an approximately 6 cm diameter structure in the posterior aspect of the bladder, suggestive of a foreign body that could potentially be located within the vagina. A rectal examination was performed, revealing a mobile, firm mass of approximately the same size on the left side, indicating that the foreign body was located in the vagina. Consultations were made with the Obstetrics and Gynecology, as well as General Surgery departments. General surgery did not consider immediate intervention necessary. The patient was admitted to the Obstetrics and Gynecology service for further investigation and treatment. It was decided that the foreign body would be removed under sedation in the operating room. Upon evaluation, a firm object was encountered approximately 5 cm inside the vaginal entrance, which was grasped with forceps and extracted using an ovarian clamp. No additional foreign bodies were identified. Suturing or cauterization was not deemed necessary for the minimal bleeding observed in the vagina. The patient was discharged in good condition on the second postoperative day.
Intravaginal foreign body on axial CT scan.
Intravaginal foreign body on coronal CT scan.
Intravaginal foreign body on sagittal CT scan.
DISCUSSION
Vaginal foreign bodies can cause nonspecific symptoms such as prolonged and malodorous vaginal discharge, intermittent genital bleeding, and dysuria, regardless of their localization. A rare but significant finding associated with vaginal foreign bodies is vaginal atresia, which typically manifests as a complication (3).
Vaginal foreign bodies are more commonly observed in children (4). In adults, they can present with various symptoms including vaginal discharge, bleeding, and abdominal pain. Abdominal pain can be present in up to 20% of these cases (2). Intravaginal foreign bodies are typically detected through gynecological examination or imaging studies. However, in our case, the patient presented to the emergency department with nonspecific complaints such as nausea and abdominal pain, rather than typical symptoms associated with vaginal foreign bodies. We attribute this presentation to the patient’s existing mental retardation.
In cases of vaginal foreign bodies, obtaining a comprehensive history poses a challenge in both pediatric and adult patients. Due to ethical and societal pressures, sufficient information may not be obtained during the history-taking process. Consequently, the time taken to resolve the issue and the accompanying problems become significant. In the case we reported, no information regarding the incident could be obtained from the family, and the patient’s cerebral palsy further complicated the history-taking process. Such incidents can occur not only due to accidents or abuse but also as a result of curiosity in children or patients with developmental disabilities, combined with inadequate education and negligence on the part of the family.
When vaginal foreign bodies are located near adnexal structures, particularly in cases involving computed tomography imaging, they can mimic adnexal masses depending on the nature of the foreign body (2). In our case, the foreign body was located intravaginally.
Removal of foreign bodies typically does not pose significant challenges. Following cystoscopy or vaginoscopy, once the normal anatomy is visualized and the foreign body is identified, it can be extracted (5). However, in cases where the hymen is intact, obtaining formal consent from the family before the procedure is essential to prevent potential legal issues in the future. In our patient, a legal report was filed, and consent was obtained from the family. Evaluation revealed that the hymen was not intact.
In conclusion, vaginal foreign bodies should be considered in the differential diagnosis of abdominal pain, particularly in female patients with mental retardation such as cerebral palsy or psychiatric disorders such as schizophrenia.
REFERENCES
1. Karkıner, A., Temir, G., & Karaca, İ. (2003). Seyrek görülen bir vajinal yabancı cisim. Çocuk Sağlığı ve Hastalıkları Dergisi, 46, 126-127.
2.ONUR, M. R., YILDIZ, M., GÜRGER, M., GÜRBÜZ, Ş., & KAVAK, S. B. Adneksial Kitleyi Taklit Eden Nadir Bir Karın Ağrısı Nedeni: Vajende Yabancı Cisim. F.Ü.Sağ.Bil.Tıp Derg. 2011; 25 (3): 133 – 136
3.Rüttgers H, Leucht W, Kubli F. Secondary vaginal atresia: a case report. Am J Obstetr Gynecol 1982; 143: 595-596.
4. Balcı O, Göktepe H, Mahmoud AS, Acar A. Intravaginal foreign bodies placed in the vagina to treat uterine prolapse retianed for 35 years. Taiwan J Obstet Gynecol 2009; 48(4): 431-433.
5. can Pohoven A, de Kernion JB. Clinical management of foreign bodies of the genitourinary tract. J Urol 2000; 164: 274-287.
