BMJ Case Reports 2012; doi:10.1136/bcr-2012-007540
  • Images in…

Acute renal failure and multiple fistulae formation related to an unusual vaginal foreign body

  1. Claudia Munn2
  1. 1IVF Unit, Hammersmith Hospital, London, UK
  2. 2Department of Gynaecology, Royal Sussex County Hospital, Brighton, UK
  1. Correspondence to Georgios Christopoulos, geoichristopoulos{at}


A 52-year-old patient presented with suprapubic pain, mild vaginal bleeding and continuous urinary incontinence. The patient was nulliparous with a history of cerebral palsy and mild learning difficulties. A bimanual examination revealed a hard and calcified vaginal mass, which appeared to be in direct continuation with her cervix. Investigations revealed leucocytosis (white blood cell count: 26.7×106/ml), raised C reactive protein (69 mg/l), urea (41.6 mmol/l) and creatinine (202 mcg/l), hyponatraemia (120 mmol/l) and hyperkalaemia (7.5 mmol/l).

Following acute management of the deranged renal function and electrolytes, she underwent CT of her abdomen and pelvis (figure 1). The findings included normal ovaries and a small uterus with a calcified mass in the upper vagina extending to all fornices. A separate calcified mass was identified inside the bladder. She denied the presence of a ring pessary.

Figure 1

Pelvic CT of patient.

The patient underwent total abdominal hysterectomy and bilateral salpingoophorectomy. During the procedure, a completely calcified aerosol cap was identified in the vagina (figure 2). The cap had been placed in the vagina facing downwards. The foreign object had eroded through the bladder wall and had created a vesicovaginal and right ureterovaginal fistula. The patient had a right ureteric re-implantation and correction of the vesicovaginal fistula.

Figure 2

Surgical specimen.

When interviewed further, she denied any history of sexual or physical abuse. She did not wish to disclose why she had inserted the cap.

Vesicovaginal fistulae secondary to foreign bodies have been reported previously.1 The images highlight the diagnostic challenge we faced because of incomplete history and significant morbidity associated with foreign vaginal bodies.

Learning points

  • Vaginal foreign bodies may have significant sequelae, including acute life-threatening renal failure and fistula formation.

  • History alone may not always highlight the aetiology of symptoms in these sensitive cases.


  • Competing interests None.

  • Patient consent Obtained.


Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article