# Vaginal Perforations After Fecal Management System Use in Critically Ill Patients: A Case Series

## TL;DR

This case series reports two instances of vaginal perforations in critically ill ICU patients after using fecal management systems, highlighting a rare but serious complication.

## Contribution

The paper introduces vaginal perforation as a previously unreported complication of fecal management system use in critically ill patients.

## Key findings

- Two critically ill patients developed vaginal perforations after prolonged fecal management system use.
- Conservative management was required due to the patients' unstable condition.
- Coagulopathies like DIC may increase the risk of such complications.

## Abstract

Fecal incontinence is a relatively common condition in patients admitted to the intensive care unit (ICU). Fecal management systems (FMS) were developed to divert stool away from the skin. While they have benefits, rare but serious complications can occur. This case series discusses two cases of vaginal perforations following FMS use in critically ill patients. An 87-year-old female was admitted twice to the ICU for infective endocarditis and bacterial pneumonia. During her second ICU stay, an FMS device was in place for up to 19 days, after which a vaginal perforation with stool leakage from the vagina was noted. In the second case, a 34-year-old female was admitted following disseminated intravascular coagulation (DIC) from a likely amniotic fluid embolism. An FMS was in situ for four days before a vaginal perforation, with stool leakage from the vagina, occurred. In both cases, neither patient was stable for an exam under anesthesia with possible repair, and therefore conservative management was pursued. Vaginal perforations can occur with FMS, and healthcare workers should be aware of this possible complication. Critically ill patients are at greater risk due to comorbid conditions that may impair tissue integrity, lead to possible fistula formation, and impede successful repair. While currently not listed in manufacturer guidelines, coagulopathies, including DIC, may be considered a relative contraindication for FMS use. Like other medical devices, FMS should be monitored for correct indication and proper placement and be regularly reassessed.