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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 18  |  Issue : 3  |  Page : 220-222

Spectrum of vaginal foreign body in children: A report of two cases


1 Department of Pediatric Surgery, Dr. B. C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
2 Department of Pediatric Medicine, Dr. B. C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India

Date of Web Publication7-Jun-2017

Correspondence Address:
Pankaj Halder
Saroda Palli, Panchanon Tala, Baruipur, Kolkata - 700 144, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_111_16

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  Abstract 

An extraordinary type of foreign body (FB) may be found in the female external genitalia, especially in children. Intravaginal FB, retained for long duration, can produce diagnostic dilemma. Vaginal bleeding as the result of a leech bite is extremely rare although reported. We report two cases of vaginal FB (intravaginal Scotch-Brite in a 5-year-old girl and leech in the vagina in a 7-year-old girl).

Keywords: Foreign body, leech, purulent, vagina


How to cite this article:
Halder P, Mandal KC, Mishra L, Debnath B. Spectrum of vaginal foreign body in children: A report of two cases. Indian J Paediatr Dermatol 2017;18:220-2

How to cite this URL:
Halder P, Mandal KC, Mishra L, Debnath B. Spectrum of vaginal foreign body in children: A report of two cases. Indian J Paediatr Dermatol [serial online] 2017 [cited 2017 Nov 23];18:220-2. Available from: http://www.ijpd.in/text.asp?2017/18/3/220/206052


  Introduction Top


Children insert an unbelievable variety of objects (safety pins, hair grips, pencils, small jam jars, toys, sweets, hairpins, and toilet paper) into the vagina mainly out of the curiosity. Usually, they present with a foul-smelling purulent discharge with or without vaginal bleeding. Here, we present our experience with two unusual cases of intravaginal foreign body (IVFB), their management with a brief review of literature.


  Case Reports Top


Case 1

A 5-year-old girl presented with foul-smelling vaginal discharge for 3 months. She did not give any history of trauma or placing an object in the vagina. The patient was admitted for evaluation under anesthesia (EUA) and genitoscopy. On EUA, we found that the vaginal lumen was filled with thick foul-smelling pus. After draining the pus, we discovered multiple pieces of Scotch-Brite deep in the vagina [Figure 1]. Although it was deeply impacted, we could remove the FB simply with an artery forceps. The vaginal lumen was thoroughly irrigated with normal saline (NS). The hymen was intact. Anesthesia recovery was uneventful and the patient was fit to discharge after 4 h. At 3-month follow-up, the child was symptomless.
Figure 1: EUA in a 5-year old girl shows pus-filled vaginal lumen due to multiple pieces of Scotch-Brite

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Case 2

A 7-year-old girl was brought to the pediatric surgery department with vaginal bleeding for 2 days following a leech bite. She described, something entering in her vagina while passing urine in a garden. Immediately, she stood up and saw a leech entering to her vagina. She grabbed the tail of the leech with fingertips, but it slipped off and entered the vaginal lumen completely. She was restless and having continuous bleeding from the vagina. Suddenly, the tail of the leech appeared out of the vagina while her mother was calming her down and trying to see the vagina. Her mother grabbed the leech's tail with fingertips and could remove it. In spite of this, there was continuous oozing from the vagina even after 48 h.

During examination at outpatient department, we could appreciate vaginal oozing but not the oozing point. Ultrasonography (USG) did not find any remnant of FB (leech). On EUA, an impacted FB was seen in the vagina which was taken out by an artery forceps [Figure 2]. It was probably a partially bloated leech (4 cm × 3 cm) stained with old blood clots. We washed the vaginal lumen with NS and search for no active oozing point. We observed the patient over 24 h, and there was no further oozing. The patient was discharged with analgesic and antibiotics. After 2 weeks, the patient came to follow-up clinic, and there was no evidence of oozing, infection, or allergic reactions.
Figure 2: EUA in a 7-year-old girl with leech bite vaginal injury shows partially bloated leech stained with old blood

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  Discussion Top


The IVFB is an interesting entity to every clinician. Young children tend to explore all orifices and thus often place a variety of small objects in the vagina and forget about it. The condition may also be occurred by an accident, in child abuse and in mentally retarded child. It is difficult to ascertain the true incidence as the child may not be able to narrate the proper history. However, a few children are smart enough to say that they have lost an object in their vagina. Depending on the nature and size of the IVFB, it may produce symptoms immediately or be asymptomatic for long periods of time. The most common symptom is foul-smelling vaginal discharge.[1] Other less common presenting symptoms are pain and discomfort due to sharp and irregular edges of the FB and associated infections. Long-standing presence of an IVFB may cause vesicovaginal fistula, urinary incontinence, systemic infection, and rarely, perforation through the vagina into the abdominal cavity.[2] Thus, in cases of chronic, antibiotic resistant vaginal discharge and lower abdominal pain, the probability of an IVFB should always be suspected, especially in young girls. Most of the time, IVFB is discovered during EUA. USG and X-ray are not much helpful.[3] Proper visualization and removal with a forceps is simple, easy and most effective procedure for IVFB. Major surgical interventions or specific repair procedures are rarely indicated, especially where there is perforation of the vaginal wall and peritonitis.[4]

A living arthropod (leech) in the vagina is extremely rare. The leech is a sanguinivorous hermaphrodite. People, who are visiting muddy areas or walking in slow-moving small rivulets, are the usual victims. The victims are unaware to leech attack since it secretes anesthetic chemicals during its movement. Sometimes, it enters into the body cavity through the natural human orifices. Bleeding from the nose, pharynx, larynx, esophagus, rectum, bladder, vagina, and urethra due to leech bite is known complications. Bleeding from a leech bite wound can persist as long as 7 days. Because its saliva contains histamine-like vasodilator, hyaluronidase, hirudin (a potent antithrombin), and calin (a platelet aggregation inhibitor). It can suck and store blood up to ten times its body size. The suckers of the leech serve as organs of locomotion and adhesion to the host's body.[5] Removal of the leech from the vagina is not easy. Moreover, hasty removal of the leech may cause the jaws to remain behind causing uncontrolled bleeding from the site of contact. Sometimes, it perforates the vaginal wall and enters into the abdomen. Saha and Nagi had reported an intraperitoneal leech, which entered through vagina and uterus in a 2-year-old girl. The treatment of intravaginal leech is EUA with or without genitoscopy followed by removal of blood clots, evaluation of oozing, and removal of remnants of leech (if any).[6] Only one case was reported in literature till now where the leech was actually found in the vagina during EUA. Leech removal from the skin surface can be augmented by application of salt, alcohol, or vinegar. For vesical hirudiniasis, infusion of NS into the bladder is recommended as it augments expulsion of leech through urethra.[7] Endoscopy is reserved for failure cases. Apart from this, care should be taken for timely detection of complications such as wound infection and allergic reaction to leeches. Usually, antihistamines and steroids are sufficient to resolve the allergic reaction.

Acknowledgments

We would like to thank Professor Biswanath Mukhopadhyay (MS, M. Ch, FICS, FRCS [Edin], FRCS [Glas]), Ex-Head of the Department, Pediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, India.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Singh RR, Ghotra HS, Garg R, Kaur R. An unusual foreign body in the vagina producing vesicovaginal fistula. IOSR J Dent Med Sci 2013;6:72-3.  Back to cited text no. 1
    
2.
Chinawa J, Obu H, Uwaezuoke S. Foreign body in vagina: An uncommon cause of vaginitis in children. Ann Med Health Sci Res 2013;3:102-4.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Hunter TB, Taljanovic MS. Foreign bodies. Radiographics 2003;23:731-57.  Back to cited text no. 3
[PUBMED]    
4.
Stricker T, Navratil F, Sennhauser FH. Vaginal foreign bodies. J Paediatr Child Health 2004;40:205-7.  Back to cited text no. 4
[PUBMED]    
5.
Naidu K, Chung A, Mulcahy M. An unusual urethral foreign body. Int J Surg Case Rep 2013;4:1052-4.  Back to cited text no. 5
[PUBMED]    
6.
Saha M, Nagi S. Intraperitoneal leech: A rare complication of leech bite. J Indian Assoc Pediatr Surg 2011;16:155-7.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Alam S, Das Choudhary MK, Islam K. Leech in urinary bladder causing hematuria. J Pediatr Urol 2008;4:70-3.  Back to cited text no. 7
[PUBMED]    


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