Images in Gynecologic Surgery
An Earring Incidentally Diagnosed and Removed Through Two-Step Vaginoscopy in a Pubertal Virgin Girl With Miliary Tuberculosis Attilio Di Spiezio Sardo, MD, PhD*, Costantino Di Carlo, MD, Marialuigia Spinelli, MD, Brunella Zizolfi, MD, Loredana Mara Sosa Fernandez, MD, and Carmine Nappi, MD From the Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples ‘‘Federico II,’’ Naples, Italy (all authors).
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A vaginal foreign body is detected in approximately 4% of pediatric gynecologic outpatient examinations [1]. Vaginoscopy using small-diameter hysteroscopes is a safe, convenient, and efficient diagnostic and therapeutic method in such cases [2,3]. Herein is reported an exceptional case of an earring in the vagina, which was incidentally detected at abdominopelvic radiography in a virgin adolescent girl and removed via 2-step vaginoscopy using miniature instruments. Case Report The patient had been hospitalized for treatment of miliary tuberculosis. At pelvic radiography, a foreign body resembling an earring was observed at the right side of the pubic symphysis (Fig. 1A). Office vaginoscopy revealed the presence of a metallic earring stuck in the right vaginal wall nearly 12 mm from the introitus. The earring was removed using a 5F grasping forceps with teeth (crocodile forceps), with moderate traction (Fig. 1B). At in-patient vaginoscopy, a 5F bipolar electrode (Karl Storz GmbH & Co., T€ uttlingen, Germany) was used to cut the fibrous bridges of the granuloma around the screw of the earring (Fig. 1C). The granuloma was emptied, and mucous yellowish liquid
The authors have no commercial, proprietary, or financial interest in the products or companies described in this article. Corresponding author: Attilio Di Spiezio Sardo, MD, PhD, Department of Gynecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples ‘‘Federico II,’’ Via Pansini 5, Naples, Italy. 1553-4650/$ - see front matter Ó 2014 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2013.05.017
was drained (Fig. 1D). Despite emptying of the granuloma, the screw continued to be adherent to the base of the granuloma and could not be removed using only the crocodile forceps. However, using 2 miniature instruments (a bipolar electrode inserted in the operative channel of the hysteroscope and the crocodile forceps on the guide of the external sheath of the hysteroscope under endoscopic vision [Fig. 1E]), the screw of the earring was safely removed, avoiding cutting too deeply into the vaginal wall and without any significant bleeding (Fig. 1F). When the earring was shown to the patient’s mother (Fig. 1G), she recognized it as a present she had given her daughter nearly 8 years before. The patient confirmed that she had not used that earring for about 8 years.
References 1. Paradise JE, Willis ED. Probability of vaginal foreign body in girls with genital complaints. Am J Dis Child. 1985;139:472. 2. Golan A, Lurie S, Sagiv R, Glezerman M. Continuous-flow vaginoscopy in children and adolescents. J Am Assoc Gynecol Laparosc. 2000;7: 526–528. 3. Moghadami-Tabrizi N, Dabirashrafi H, Mohammad K, Ghafari VV. Surgical vaginoscopy. J Am Assoc Gynecol Laparosc. 1994;1(4 Pt 2):S23.
E-mail: [email protected] Submitted May 20, 2013. Accepted for publication May 23, 2013. Available at www.sciencedirect.com and www.jmig.org
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Fig. 1 (A) At pelvic radiography, a radiopaque foreign body resembling an earring was observed at the right side of the pubic symphysis. (B) Office vaginoscopy revealed the presence of a metallic earring stuck in the right vaginal wall nearly 12 mm from the introitus, which was removed using grasping forceps with teeth. (C–G) Procedure for removal of the screw of the earring from the vagina at inpatient vaginoscopy.
An Earring Incidentally Diagnosed and Removed Through Two-Step Vaginoscopy in a Pubertal Virgin Girl With Miliary Tuberculosis Attilio Di Spiezio Sardo, MD, PhD*, Costantino Di Carlo, MD, Marialuigia Spinelli, MD, Brunella Zizolfi, MD, Loredana Mara Sosa Fernandez, MD, and Carmine Nappi, MD From the Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples ‘‘Federico II,’’ Naples, Italy (all authors).
DISCUSS
You can discuss this article with its authors and with other AAGL members at http://www.AAGL.org/jmig-21-1-JMIG-D-13-00294
Use your Smartphone to scan this QR code and connect to the discussion forum for this article now* * Download a free QR Code scanner by searching for ‘‘QR scanner’’ in your smartphone’s app store or app marketplace.
A vaginal foreign body is detected in approximately 4% of pediatric gynecologic outpatient examinations [1]. Vaginoscopy using small-diameter hysteroscopes is a safe, convenient, and efficient diagnostic and therapeutic method in such cases [2,3]. Herein is reported an exceptional case of an earring in the vagina, which was incidentally detected at abdominopelvic radiography in a virgin adolescent girl and removed via 2-step vaginoscopy using miniature instruments. Case Report The patient had been hospitalized for treatment of miliary tuberculosis. At pelvic radiography, a foreign body resembling an earring was observed at the right side of the pubic symphysis (Fig. 1A). Office vaginoscopy revealed the presence of a metallic earring stuck in the right vaginal wall nearly 12 mm from the introitus. The earring was removed using a 5F grasping forceps with teeth (crocodile forceps), with moderate traction (Fig. 1B). At in-patient vaginoscopy, a 5F bipolar electrode (Karl Storz GmbH & Co., T€ uttlingen, Germany) was used to cut the fibrous bridges of the granuloma around the screw of the earring (Fig. 1C). The granuloma was emptied, and mucous yellowish liquid
The authors have no commercial, proprietary, or financial interest in the products or companies described in this article. Corresponding author: Attilio Di Spiezio Sardo, MD, PhD, Department of Gynecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples ‘‘Federico II,’’ Via Pansini 5, Naples, Italy. 1553-4650/$ - see front matter Ó 2014 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2013.05.017
was drained (Fig. 1D). Despite emptying of the granuloma, the screw continued to be adherent to the base of the granuloma and could not be removed using only the crocodile forceps. However, using 2 miniature instruments (a bipolar electrode inserted in the operative channel of the hysteroscope and the crocodile forceps on the guide of the external sheath of the hysteroscope under endoscopic vision [Fig. 1E]), the screw of the earring was safely removed, avoiding cutting too deeply into the vaginal wall and without any significant bleeding (Fig. 1F). When the earring was shown to the patient’s mother (Fig. 1G), she recognized it as a present she had given her daughter nearly 8 years before. The patient confirmed that she had not used that earring for about 8 years.
References 1. Paradise JE, Willis ED. Probability of vaginal foreign body in girls with genital complaints. Am J Dis Child. 1985;139:472. 2. Golan A, Lurie S, Sagiv R, Glezerman M. Continuous-flow vaginoscopy in children and adolescents. J Am Assoc Gynecol Laparosc. 2000;7: 526–528. 3. Moghadami-Tabrizi N, Dabirashrafi H, Mohammad K, Ghafari VV. Surgical vaginoscopy. J Am Assoc Gynecol Laparosc. 1994;1(4 Pt 2):S23.
E-mail: [email protected] Submitted May 20, 2013. Accepted for publication May 23, 2013. Available at www.sciencedirect.com and www.jmig.org
Di Spiezio Sardo et al.
Two-Step Vaginoscopy in a Pubertal Virgin Girl
177
Fig. 1 (A) At pelvic radiography, a radiopaque foreign body resembling an earring was observed at the right side of the pubic symphysis. (B) Office vaginoscopy revealed the presence of a metallic earring stuck in the right vaginal wall nearly 12 mm from the introitus, which was removed using grasping forceps with teeth. (C–G) Procedure for removal of the screw of the earring from the vagina at inpatient vaginoscopy.
