Differential Diagnosis
- Single most likely diagnosis
- Vaginal mesh erosion or exposure: This is the most likely diagnosis given the patient's history of anterior and posterior colporrhaphy with mesh placement and her report of the mesh coming loose. The symptoms of a bulge and mesh exposure are consistent with this diagnosis.
- Other Likely diagnoses
- Vaginal cuff dehiscence: This is a possible diagnosis given the patient's report of a bulge and the mesh coming loose. The lack of fever and chills makes this less likely, but it is still a possibility.
- Pelvic organ prolapse: The patient's report of her bladder being "out about 2 in" suggests a pelvic organ prolapse, which could be related to the mesh coming loose or a failure of the previous surgical repair.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although the patient denies fever and chills, it is still possible that she could be developing sepsis, especially if the mesh exposure is infected. Sepsis is a life-threatening condition that requires prompt diagnosis and treatment.
- Bowel injury or perforation: If the mesh has eroded into the bowel, it could cause a bowel injury or perforation, which would be a life-threatening condition.
- Rare diagnoses
- Erosion of the mesh into the urethra or ureters: This is a rare but possible complication of mesh placement, and could cause symptoms such as urinary incontinence or obstruction.
- Fistula formation: The mesh exposure could potentially lead to the formation of a fistula between the vagina and another organ, such as the bladder or bowel.