Giant Vaginal Phlebolith – Lesson Forgotten

Abstract

Mrs. R, 54-year-old housewife, presented to A&E, with a history of gross vaginal bleed since the last 12 days. She gave history of complete urinary incontinence since the last 8 years and intermittent vaginal spotting since the past few years. Her past medical history did not show any systemic illness. Her gynecological history revealed that she was grand multipara (G9P8A1). All the deliveries were vaginal and conducted at home. An obstructed labour resulting in stillbirth complicated her last delivery. On examination, Mrs. R was middle-aged lady having poor socio-economic background. She was apyrexial and normotensive. She was tachycardiac with pulse rate of 104/min. Abdominal examination revealed deep tenderness in the suprapubic region. A deep seated hard mass could be felt in the pelvis. Her other abdominal viscera were not palpable. Her vaginal examination revealed maceration and excoriation of the vulva and medial side of thighs due to persistent leakage of urine which was foul smelling and haemorrhagic at the time of presentation. Inspection of the vagina showed big occlusive calcareous mass just within the vaginal outlet. Digital rectal examination confirmed presence of big stony hard mass in the vagina, the upper limit of which could not be reached from below. It was mobile on bimanual examination. Laboratory examination revealed Hb. of 8.3gms/dl, and white cell count of 8600/ml. Her Urea and electrolytes were within normal limits. X-Ray of the pelvis showed a big inverted conical opacity in the pelvis. Her Ultrasound scan did not show any hydronephrosis or any other abnormality in the remaining abdominal viscera, however the pelvis could not be examined as the bladder was empty due to continuous leakage of urine.