Conservative management of a rectovaginal fistula caused by a Gellhorn pessary. A case report

A 72-year-old woman presented with stage III pelvic organ prolapse (POP) and chose a vaginal support device (VSD) after discussing the various options. Different types and sizes were tried, a Gellhorn pessary was inserted, and the woman was comfortable and able to retain it. The woman was advised to attend follow-up after 3 months. Unfortunately, she did not. She presented complaining of the passage of minimal feculent vaginal discharge 5 months after insertion. A pelvic examination was performed and showed a rectovaginal fistula (RVF). Conservative management was chosen. After 2 months, the RVF healed completely. VSDs are commonly used in the management of POP and very rarely lead to the development of RVF, mostly in neglected cases. While surgery is most often used to treat RVF, conservative management is very rarely adopted and may be considered in selected cases.