Case reports
21 November 2024
Vol. 36 (2024)
https://doi.org/10.4081/uij.2024.341

Conservative management of a rectovaginal fistula caused by a Gellhorn pessary. A case report

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Conservative management, Gellhorn pessary, pelvic organ prolapse, rectovaginal fistula
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Authors

Samaa Siyam
https://orcid.org/0000-0002-8707-9625
Department of Obstetrics and Gynecology, The Specialty Hospital, Amman, Jordan.
Ismaiel Abu Mahfouz
ismaiel.mahfouz@bau.edu.jo
Department of Obstetrics and Gynecology, Faculty of Medicine, Al Balqa’ Applied University, Al-Salt, Jordan.
Mais Al-Attar
https://orcid.org/0009-0000-8013-6087
Department of Obstetrics and Gynecology, The Specialty Hospital, Amman, Jordan.
Roaa Khatatbeh
https://orcid.org/0000-0003-3413-0025
Department of Obstetrics and Gynecology, The Specialty Hospital, Amman, Jordan.
Esraa Qandil
https://orcid.org/0009-0008-7454-5165
Department of Obstetrics and Gynecology, The Specialty Hospital, Amman, Jordan.
Leen Saifan
https://orcid.org/0009-0005-4199-8502
Department of Obstetrics and Gynecology, The Specialty Hospital, Amman, Jordan.

A 72-year-old woman presented with stage III pelvic organ prolapse (POP) and chose a vaginal support device (VSD) after discussing the various options. Different types and sizes were tried, a Gellhorn pessary was inserted, and the woman was comfortable and able to retain it. The woman was advised to attend follow-up after 3 months. Unfortunately, she did not. She presented complaining of the passage of minimal feculent vaginal discharge 5 months after insertion. A pelvic examination was performed and showed a rectovaginal fistula (RVF). Conservative management was chosen. After 2 months, the RVF healed completely. VSDs are commonly used in the management of POP and very rarely lead to the development of RVF, mostly in neglected cases. While surgery is most often used to treat RVF, conservative management is very rarely adopted and may be considered in selected cases.

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Conservative management of a rectovaginal fistula caused by a Gellhorn pessary. A case report. (2024). Urogynaecologia, 36. https://doi.org/10.4081/uij.2024.341
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