# Vaginal Ring Pessary Migration and Embedment With Rectal Prolapse: A Rare Complication of a Forgotten Ring Pessary in an Elderly Patient

## TL;DR

An elderly woman had a rare complication where a forgotten vaginal pessary migrated and caused rectal prolapse, emphasizing the need for follow-up and proper patient selection.

## Contribution

This case highlights a rare complication of long-term vaginal pessary use and the importance of recall systems and patient selection.

## Key findings

- A vaginal ring pessary embedded through the low rectum after 16 years of use.
- The pessary caused rectal prolapse and procidentia in an elderly patient.
- The pessary was successfully removed under general anesthesia with no fistula observed.

## Abstract

The use of a vaginal ring pessary is a common nonsurgical option for the management of pelvic organ prolapse. It may sometimes be considered a first-line option for patients who are not suitable surgical candidates. Pessaries generally have a good safety profile, and serious adverse complications are uncommon. However, long-term use without appropriate follow-up may lead to rare and severe complications. We report a case of vaginal ring pessary migration and embedment with rectal prolapse in an 81-year-old woman. She presented to the Emergency Department complaining of a lump in the perineum. She had a background of pelvic organ prolapse, for which a ring pessary was inserted more than 16 years ago. On examination, she was found to have procidentia and a grade 4 rectal prolapse, with a vaginal ring pessary embedded through the low rectum. The pessary was removed under general anesthesia, and no patent rectovaginal fistula was observed. She made an uneventful recovery and was discharged on the third day of admission. This rare complication of a retained vaginal pessary underscores the importance of follow-up and the need for a recall system for patients using vaginal pessaries. It also highlights that patient selection is key when offering vaginal pessary as a treatment option for pelvic organ prolapse.