Vaginal calculus formation around eroded vaginal mesh with actinomycosis presenting as postmenopausal bleeding in a post hysterectomy woman: a rare case report

Abstract

Vaginal calculi are exceptionally rare and usually develop secondary to foreign bodies, chronic infection, urinary contamination, or eroded synthetic materials. Presentation as post-menopausal bleeding is uncommon and may mimic genital tract malignancy. The coexistence of mesh erosion, actinomycosis, and vaginal calculus formation is exceedingly rare. A 68-year-old postmenopausal multiparous woman presented with bleeding per vaginum. She had undergone abdominal hysterectomy approximately 20 years earlier. Pelvic examination revealed a hard posterior vaginal wall mass suspicious for malignancy. Examination under anesthesia and vaginoscopy demonstrated a vaginal calculus surrounding eroded mesh protruding through the posterior vaginal wall. Complete removal of the calculus and exposed mesh was performed. Histopathological examination revealed actinomycosis without evidence of malignancy. The postoperative course was uneventful. Vaginal calculus formation secondary to mesh erosion with associated actinomycosis should be considered in elderly women presenting with post-menopausal bleeding. Histopathological examination is essential for excluding malignancy and confirming the diagnosis.