This is my OP note
Preoperative Diagnosis: Retained pessary.
Postoperative Diagnosis: Retained pessary.
Procedure: Examination under anesthesia, removal of a retained pessary.
Brief History: The patient is an elderly, frail 94-year-old female who has a Gellhorn pessary in place. As per my records, this has been in place for greater than 5 years without having been cleaned or changed. She is having a small amount of bleeding, but significant vaginal odor. due to the length of time that this has been in place, it is impossible to remove it in the office. She is brought for IV sedation and removal of the device. She and her family have been apprised of the risks of anesthesia and consent has been obtained.
Description of Procedure: Patient was taken to the operating room and anesthesia was established. when she had adequate sedation established, her legs were placed in the stirrups. there was noted to be clearish discharge from the vaginal vault. The knob of the Gellhorn pessary was visualized at the vaginal introitus. Initial attempts to remove the pessary were unsuccessful. Ultimately, the knob of the Gellhorn was grasped with the single-tooth tenaculum for traction with both hands, the suction was reduced, and at that point, the pessary was removed. there was a small amount of bleeding. a gentle speculum examination was carried out, which revealed some granulation tissue along the anterior and posterior walls of the vagina, but there was no active bleeding. There were no ulcerations and no fistula formation. The pessary was discarded and at the conclusion of the procedure, the patient was awakened from anesthesia and taken to the recovery room in stable condition with all counts correct.