Sonographic detection of vaginal foreign bodies

A successful pediatric case of vaginal foreign body detection on transabdominal ultrasonography

Vaginal foreign bodies usually present with bleeding and foul-smelling discharge. It is often difficult to detect and identify vaginal foreign bodies in pediatric cases without any symptoms. Therefore, detection of vaginal foreign bodies using noninvasive methods, like transabdominal ultrasonography, is important in pediatric patients.

Vaginal Foreign Bodies: The Potential Role of Point-of-Care-Ultrasound in the Pediatric Emergency Department

Transabdominal point-of-care ultrasound may be a helpful tool during the evaluation of children with suspected vaginal foreign bodies. We discuss the case of an 11-year-old girl presenting after having placed a pen into her vagina. The patient attempted to remove the pen, but there was concern the cap may have been retained in the vagina. Point-of-care ultrasound findings confirmed a retained pen cap that was subsequently removed by pediatric surgery. We discuss the role of transabdominal point-of-care ultrasound for the detection of vaginal foreign bodies in pediatric patients.

Emergent ultrasound evaluation of the pediatric female pelvis

Ultrasound is the primary imaging modality of the pediatric female pelvis and is often requested to evaluate girls with pelvic or abdominal pain or abnormal bleeding. The US interpretation can help guide the clinician toward medical or surgical management. Here we discuss the normal US anatomy of the female pelvis and illustrate, through case examples, conditions encountered when performing emergent pelvic US for common and uncommon clinical scenarios.

Use of hysteroscope for vaginoscopy or hysteroscopy in adolescents for the diagnosis and therapeutic management of gynecologic disorders: a systematic review

STUDY OBJECTIVE

The purpose of this article is to review the published literature and perform a systematic review to evaluate the effectiveness and feasibility of the use of a hysteroscope for vaginoscopy or hysteroscopy in diagnosing and establishing therapeutic management of adolescent patients with gynecologic problems.

DESIGN

A systematic review.

SETTING

PubMed, Web of science, and Scopus searches were performed for the period up to September 2013 to identify all the eligible studies. Additional relevant articles were identified using citations within these publications.

PARTICIPANTS

Female adolescents aged 10 to 18 years.

RESULTS

A total of 19 studies were included in the systematic review. We identified 19 case reports that described the application of a hysteroscope as treatment modality for some gynecologic conditions or diseases in adolescents. No original study was found matching the age of this specific population.

CONCLUSIONS

A hysteroscope is a useful substitute for vaginoscopy or hysteroscopy for the exploration of the immature genital tract and may help in the diagnosis and treatment of gynecologic disorders in adolescent patients with an intact hymen, limited vaginal access, or a narrow vagina.

Long-retained vaginal foreign body causing chronic vaginitis in a bulldog

A vaginal foreign body consisting of a piece of retained calvarium from a macerated fetus was identified and removed using vaginoscopy in a 4-year-old, spayed female bulldog. The dog had a 12-month history of chronic mucopurulent vaginitis. Vaginal foreign bodies, although uncommon, are a differential diagnosis for recurrent mucopurulent or hemorrhagic chronic vaginal discharge. A case of chronic vaginitis caused by a long-retained intravaginal foreign body in a dog is described and compared to four other canine cases reported in the literature.

Premenarchal vaginal discharge: findings of procedures to rule out foreign bodies

STUDY OBJECTIVE

Vaginal discharge in children is a common gynecologic complaint and may be resistant to symptomatic and/or antibiotic treatment. In recurrent or unresponsive patients, an evaluation to rule out a foreign body is traditionally recommended. The objective of this study is to review cases of vaginal discharge referred to our institution and assess outcome and diagnosis in those who required irrigation or vaginoscopy to rule out a foreign body.A retrospective chart review was performed on all premenarchal girls identified through the University of Michigan Pediatric and Adolescent Gynecology Clinic database who were seen for evaluation of vaginal discharge between June 1996 and December 2001. The records were reviewed for age, length of time of discharge, aspects of discharge, procedures done to rule out foreign bodies, and findings of such procedures.

SETTING

The study was performed in a tertiary care university hospital.

PARTICIPANTS

Forty-one premenarchal girls were evaluated for vaginal discharge. The average age was 6.0 yr (range 3 months-11 yr).

RESULTS

The average duration of vaginal discharge prior to presentation was 13.7 months (range 1-42 months). Of the 41 girls, 18 girls underwent 1 procedure each, 2 girls underwent 2 procedures each, and 1 girl underwent 5 procedures. Ten vaginal irrigations in clinic were performed in 7 girls, 3 by the referring physician and 7 by us. These irrigations removed a foreign body (tissue paper) in 4 of 10 (40%) cases, 3 at our institution and 1 at an outside institution. In the three irrigation cases with foreign bodies performed at our institution, the foreign body was visible on genital examination prior to the irrigation. Seventeen vaginoscopies under anesthesia were performed in 16 girls, 5 by the referring physician and 12 by us. In the girls who underwent a vaginoscopy under anesthesia a foreign body was found in 3 of 17 (17.6%). The other findings of the vaginoscopies included: biopsy-proven severe dermatitis with no infection in 1 patient, lymphatic duct chylous drainage in 1 patient, nonspecific vulvovaginitis in 11 patients, and normal exam with eventual diagnosis of malingering in 1 patient. In all cases where a foreign body was identified, the patient presented with bloody or brown discharge.

CONCLUSIONS

Foreign bodies as a cause of persistent vaginal discharge in a tertiary care referral clinic were identified in 4 of 41 girls (9.8%) and 7 of 27 procedures (25.9%). One child had recurrent foreign bodies removed during 4 of 5 procedures for discharge. In children with persistent vaginal discharge, vaginal irrigation was feasible in older children (average age 7.7 yr). However, no foreign bodies were removed by irrigation that had not already been visually identified prior to the procedure. Exam under anesthesia and vaginoscopy allowed the identification of foreign bodies, and it facilitated the diagnosis of other unusual conditions.

Continuous-flow vaginoscopy in children and adolescents

STUDY OBJECTIVE

To assess the role of continuous-flow vaginoscopy in the management of gynecologic problems in pediatric and adolescent patients.

DESIGN

Prospective, observational study (Canadian Task Force classification II-3). Setting. University-affiliated teaching hospital.

PATIENTS

Twenty-two consecutive children and adolescents evaluated for vulvovaginitis (15), vaginal trauma (4), bleeding (2), and genital malformation (1).

INTERVENTION

Continuous-flow vaginoscopy with a 4-mm hysteroscope under general anesthesia.

MEASUREMENTS AND MAIN RESULTS

Vaginal walls, fornices, and cervices were well visualized in all patients. No pathologic findings were found in 16, a foreign body was present in 3, and vaginal lacerations in 3. Foreign material was removed with long straight forceps, bleeding spots were coagulated, and lacerations sutured. No complications occurred. The patients were discharged 4 to 24 hours after the procedure.

CONCLUSION

Diagnosis of gynecologic problems in children and adolescents should include vaginoscopy. Continuous-flow vaginoscopy is quick and easy to perform in these patients.