Nonsurgical Management of a Rectovaginal Fistula Caused by a Gellhorn Pessary

BACKGROUND: Pessaries are generally thought to be a safe, well-tolerated treatment for pelvic organ prolapse. CASE: An 85-year-old woman had a Gellhorn pessary placed for pelvic organ prolapse. Although she was seen regularly for care, the pessary had not been removed for several years. She presented stating that she felt the pessary had shifted. On examination, the patient's pessary stem had eroded through the vagina into the rectum. The pessary was removed and the patient was treated with vaginal estradiol cream. One month later the fistula tract had resolved and the patient continued to desire a pessary to manage her pelvic organ prolapse. CONCLUSION: Pessaries require care and maintenance. Patients' desires for conservative management should be coupled with education and routine follow-up.