Vaginal burn injury due to alkaline batteries

Vaginal foreign body in the pediatric patient: A systematic review

BACKGROUND

Vaginal foreign bodies represent a clinical and diagnostical challenge in pediatric gynecology. Several case reports, case series and retrospective studies have been published, highlighting rare or complex cases. A comprehensive systematic review is lacking.

METHODS

Published English-language articles on vaginal foreign objects in patients aged 16 years and younger, with full-text availability were included. Articles on adult patients and patients with an object migrating from the abdominal cavity into the vagina were excluded.

RESULTS

Out of the 215 screened articles 75 were included, comprising a total of 522 patients. The age ranged from 6 months to 16 years, with an average of 6 years and 3 months. The presenting symptoms were documented in 340 patients, with the two most common being vaginal bleeding (n = 172) and vaginal discharge (n = 134). Toilet paper or tissue was the most common object, in 155 out of 447 patients. Ultrasonography was the most utilized diagnostic method, with a sensitivity of 79.9 %. Radiography showed more false-negative than true-positive results, with a sensitivity of 33.3 %. Complications were reported in 35 patients. Evidence of sexual abuse was found in a small group of 16 patients. Vaginoscopy under sedation was the most frequently used therapeutic approach.

CONCLUSION

A swift and accurate diagnosis is crucial, with clinical examination and ultrasonography playing pivotal roles. Vaginoscopy is the gold standard for definitive diagnosis and therapy. Attention should be given to a potential context of sexual abuse.

Clinical Review: Prepubertal Bleeding

BACKGROUND

Prepubertal bleeding is a common presentation in the pediatric office and can be distressing for patients and families. A comprehensive approach to diagnosis and management allows clinicians to identify patients at risk for worrisome pathology and arrange timely care.

OBJECTIVE

We aimed to review the key features of clinical history, physical exam, and diagnostic workup of a child presenting with prepubertal bleeding. We reviewed potential pathologies requiring urgent investigations and management, such as precocious puberty and malignancy, as well as more common etiologies, including foreign bodies and vulvovaginitis.

CONCLUSION

Clinicians should approach each patient with the goal of excluding diagnoses that require urgent interventions. A thoughtful clinical history and physical exam can inform appropriate investigations to optimize patient care.

Vaginal Corrosion Due to Insertion of a 9-Volt Battery

BACKGROUND

Batteries are known to cause damage to mucosal surfaces. Unfortunately, the timing of serious sequelae and recommendations for removal of a vaginally inserted battery in a premenopausal patient are not well characterized. This case report aims to detail the timeline of events and complications after vaginal insertion of a 9-volt alkaline battery and to further clarify the recommendation for urgent removal.

CASE

A 24-year-old nulliparous woman with significant psychiatric and trauma history was admitted for ingestion and insertion of multiple foreign objects, including a 9-volt battery that she inserted into her vagina during her hospital admission. Examination under anesthesia was required for removal of the battery, with cervical and vaginal necrosis and partial-thickness burns noted. Removal occurred approximately 5.5 hours after insertion. Management included vaginal irrigation and topical estrogen.

CONCLUSION

Given our findings of rapid and severe damage to the vaginal mucosa, urgent removal of a vaginally inserted battery is indicated.

Vaginal foreign bodies in children: a single-center retrospective 10-year analysis

OBJECTIVE

To evaluate the clinical features and outcome in girls with a vaginal foreign body.

METHODS

The clinical data of 97 girls with a vaginal foreign body were collected between 2010 and 2020. The descriptive analysis was used to summarize the clinical characteristics.

RESULTS

The patients were aged between 1.5 and 14.8 years, and the age of peak incidence was shown to be 3-10 years, which accounted for 88% of the cases. Blood-stained vaginal discharge or vaginal bleeding was the most common symptom (48%). The most common foreign bodies were small hard objects (57%), followed by bits of cloth or toilet tissue (22%). The patient whose foreign object was a disk battery had the most severe symptoms. When an injury of the vaginal mucosal was suspected, antibiotics were used to prevent infection, with full recovery of all patients without any additional treatment after removal of the foreign object.

CONCLUSION

If there is no damage to the vaginal mucosa, no additional treatment is needed after the foreign body is removed. When a vaginal foreign body is suspected to be a battery, emergency surgery is needed to prevent further damage.

Endoscopic Treatment of a Severe Vaginal Stenosis Following Battery Insertion in an 11-Year-Old Girl

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.

Disk Battery as a Vaginal Foreign Body in a Five-Year-Old Preadolescent Child

The self-introduction of batteries into the vagina is exceedingly infrequent among preadolescents, with only six cases have been recorded in the English-language PubMed-indexed literature. Herein, we present the case of a five-year-old female child who presented with an 18-month history of recurrent ill-smelling vaginal discharge. Pelvic radiograph displayed a radio-opaque object, most likely representing a disk battery inside her vagina. Vaginoscopy showed a 1.2 cm disk battery that was removed from the right posterior vaginal fornix. Four weeks later, the child was doing well and symptom-free. Although rare, vaginal foreign bodies should be considered in the differential diagnosis in preadolescent girls presenting with chronic and recurrent vaginal discharge. Vaginoscopy is a useful tool diagnostically and therapeutically. A clinical summary of all PubMed-indexed cases of batteries as vaginal FBs in children is provided (n=6).

Prepubertal Vulvovaginitis

Vulvovaginitis is a common gynecologic complaint in prepubertal girls. It typically presents with complaints of vulvovaginal itching, burning, irritation, discharge, or skin changes. Prepubertal females have anatomic, physiological, and behavioral factors that most often contribute to the development of symptoms. Careful attention to history and associated complaints will direct evaluation, diagnosis, and treatment. Most cases are nonspecific in origin and treatment includes counseling to patients and parents on hygiene and voiding techniques. Antibiotic treatment for specific pathogens may be indicated. Other less common causes include foreign bodies and lichen sclerosus.

Longstanding Presence of a Vaginal Foreign Body (Battery): Severe Stenosis in a 13-Year-Old Girl

BACKGROUND

In recurrent/unresponsive vaginal discharge a vaginal foreign body should be considered.

CASE

We present the case of a 13-year-old girl who suffered from a foul-smelling dark brownish and malodorous vaginal discharge since the age of 7 years. When the girl was 11 years old, a foreign body was discovered on ultrasound imaging; removal by colposcopy failed, because of the complete battery inclusion in the posterior vaginal wall. Two years later, at our institution, radiological images yielded the general position of the foreign body; colposcopy showed complete vaginal stenosis. Forced dilatation allowed surgical removal of the battery which was embedded in the vaginal fundal wall.

SUMMARY AND CONCLUSION

Early removal of foreign objects prevents ulceration, necrosis, stenosis, perforations, and late serious sequelae such as pelvic inflammation and infertility.

Severe Vaginal Burns in a 5-Year-Old Girl Due to an Alkaline Battery in the Vagina

BACKGROUND

The ingestion or insertion of alkaline batteries in the body can cause severe damage to hollow organs. We report here a case of severe vaginal burns in a young patient caused by an alkaline battery.

CASE

A 5-year-old girl presented to our outpatient department with pelvic pain and vaginal discharge. Further workup suggested the presence of a vaginal foreign body. Under general anesthesia, an alkaline battery was removed from her vagina, which showed severe burns with partial-thickness necrosis. Complete healing was confirmed at 3 months after initial presentation.

CONCLUSIONS

In this rare case of an alkaline battery present in the vagina of a prepubescent girl, we discuss the available treatment and management options in comparison to similar previously reported cases.

Vaginal Burn from Alkaline Battery in an 8-Year-Old

BACKGROUND

Life-threatening injury from battery ingestion has mandated changes in the manufacture of battery-operated devices. Whilst esophageal burns are commonly publicized, there is scarce literature on vaginal burns and their potential morbidity.

CASE

An 8-year-old girl presented with self-report of a "fluffy toy" per vagina. Under general anesthesia, her vagina was examined and the mucosa appeared coated in a "blue fur." It was soon identified as corrosive damage from an alkaline button battery. Fistula and rectal injury were excluded. Symptomatic relief was achieved with the use of estradiol lidocaine intravaginal concoction following removal.

SUMMARY AND CONCLUSIONS

Optimal management of a vaginal foreign body relies upon clinical suspicion, familiarity with prepubertal vaginal instrumentation, and expeditious removal of inserted batteries to avoid serious morbidity.

Rapid onset of severe ocular injury after exposure to a button battery

Button batteries are commonly used in many household electronic items and are a potential health hazard, especially in children. We present the case of a 2-year-old girl presented with swelling and redness of her right eye of 3 hours' duration. Examination revealed a button battery that had became lodged in the superior fornix of her right eye. After the intact battery was removed, the patient was found to have suffered an alkali burn to the underlying conjunctiva and sclera. The burn healed with symblepharon formation.

The case of a prosthetic limb used to cause lethal intravaginal injuries: forensic medical aspects in a case of intimate partner violence

A common form of violence against women is sexual coercion on the part of their husbands/partners, the uncontrollable effects of which can lead to extreme consequences, as in the case of uxoricide examined in this report. It involved a 59-year-old female alcoholic, under observation on the part of social services as the possible victim of abuse by her husband, an amputee with a transtibial prosthesis. The woman had never admitted to her social workers that her husband was abusing her. One night, she was admitted to hospital in a state of hemorrhagic shock due to massive vaginal bleeding, but despite treatment, she died 20 min after arrival. The anatomical-pathological examination conducted by the hospital revealed serious genital lesions which warranted reporting the case to the Judicial Authorities, who arranged for a forensic autopsy. The cause of death was identified as acute meta-hemorrhagic anemia in a cirrhotic woman, secondary to a large, irregular vaginal lesion involving both the vaginal wall and the soft perivaginal tissues as well as the medium and small urogenital vascular branches. To identify the foreign body used to inflict this injury, a scanning electron microscope and energy dispersive X-ray spectrometer (SEM-EDS) were used. This revealed tiny splinters of wood in the vaginal tissues examined. In addition to the genetic-forensic techniques used, this finding allowed the investigators to identify the husband's prosthetic limb as the instrument of sexual coercion. The report describes a particular case of marital rape that resulted in uxoricide, in which the overall concordance of the investigations carried out played a fundamental role in identifying the offending body and, consequently, the murderer.

Severe ocular injury after button battery exposure

BACKGROUND

Button batteries can cause local tissue necrosis within 2h of exposure due to hydrolysis of tissue fluid and generation of hydroxide ions. Tissue damage resulting from battery exposure has been associated with acute and chronic complications via several routes, however, previous experience with ocular battery exposures is predominantly limited to batteries that have exploded or penetrated the eye.

OBJECTIVES

A case is presented of an intact battery causing significant damage after ocular exposure without penetrating the eye.

CASE REPORT

An 18-year-old woman presented to the Emergency Department after a toy balloon propelled a button battery into the patient's eye. The battery did not penetrate the orbit and was intact upon removal from the inferior fornix in the operating room 4h later. The patient had severe conjunctival ulceration, subconjunctival hemorrhage, vitreous opacification, and a partially dilated pupil, with the greatest area of injury adjacent to the negative pole of the battery. The eye was extensively irrigated and the patient was treated with topical antibiotics, steroids, and a daily rodding procedure to prevent conjunctival adhesions. The eye ultimately healed over the subsequent 6 months, with normal visual acuity on follow-up.

CONCLUSION

Prolonged ocular exposure to an intact battery can cause significant tissue necrosis, which may threaten sight. Early removal is critical to prevent significant ocular damage and visual compromise.