Actinomycotic vesico-uterine fistula from a wishbone pessary contraceptive device.
1/8/1991

Buckley P, McInerney PD, Stephenson TP.

Department of Urology, Royal Infirmary, Cardiff.

PIP: Presented is the case of a 77-year-old British women with sudden onset of vaginal bleeding and a 3-year history of urinary incontinence. A wishbone-type pessary, inserted in 1945 and never removed, was found to be the source of these symptoms. Cystoscopy revealed a large fistula at the bladder base, and bacterial culture of the pyometra grew bacteroides and actinomyces. The symptoms abated after closure of the fistula and antibiotic treatment. This is the first report of a vesico-uterine fistula due to a wishbone pessary. In the other similar case reported in the literature, a vesico-uterine fistula was related to a Maslin Spring IUD that had been inserted 14 years prior to presentation. The IUD is an ideal predisposing factor for the development of pelvic actinomycosis.