Foreign body in vagina: a cause of persistent vaginal discha
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Vaginal discharge is a common gynecological complaint among pre-pubertal children. Vulvovaginitis is the commonest cause and the main predisposing factor for the vaginal discharge is the lack of protective effect of estrogen on the vaginal mucosa making it susceptible to invasion by pathogens. Persistent vaginal discharge in these children not responding to antibiotics should be investigated further to rule out rare causes like a foreign body in the vagina or vaginal tumors. Foreign body in the vagina can cause foul-smelling and blood-stained vaginal discharge, abdominal pain, and serious complications like perforation through the walls of the vagina leading to vesicovaginal or recto-vaginal fistula as well as systemic infection.

A 2-year-old girl was brought by her parents with complaints of greenish foul-smelling discharge from vagina for the past 2 weeks. The child was apparently normal 20 days back when she developed low-grade fever which was treated symptomatically. Later, she developed greenish color foul-smelling discharge from the vagina. There was no history of fever, incessant crying, trauma, or child abuse. Local examination revealed no signs of injury or excoriation marks on the vulva, hymen appeared intact, and minimal greenish discharge was seen at introitus. Routine investigations revealed a raised total leukocyte count and urinary tract infection. The culture of the vaginal discharge revealed acinetobacter which was treated with appropriate antibiotics. Ultrasound was done as there was a high index of suspicion for a foreign body in the vagina due to the persistent nature of the vaginal discharge. Transabdominal ultrasound was reported normal and but transperineal ultrasound revealed a hyperechoic mass with acoustic shadowing in the lower part of the vagina.

The patient underwent vaginoscopy and on entering the introitus, approximately 2 cm from the hymen a disc battery was identified and removed. There were no more foreign bodies inside the vagina, no ulceration of the vaginal walls, and the cervix appeared normal. The patients stood the procedure well and was discharged from the hospital the next day.