Differential Diagnosis for Malodorous Vaginal Discharge
- Single most likely diagnosis
- Retained vaginal packing: The patient had vaginal packing placed after a forceps-assisted vaginal delivery, which is a common cause of malodorous discharge if the packing is not fully removed. The presence of a tan-brown discharge and a dark red, velvety area on the posterior vaginal wall supports this diagnosis.
- Other Likely diagnoses
- Endometritis: Although the patient's lochia stopped a week ago, endometritis is still a possible cause of malodorous discharge, especially given the history of a complicated delivery.
- Vaginal infection (e.g., bacterial vaginosis): The patient's symptoms of malodorous discharge could be consistent with a vaginal infection, although the presence of a specific lesion on the posterior vaginal wall makes this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Necrotizing fasciitis: Although rare, necrotizing fasciitis is a life-threatening condition that can occur after a traumatic delivery. The presence of a malodorous discharge and a dark red, velvety area on the posterior vaginal wall could be indicative of this condition.
- Septic pelvic thrombophlebitis: This is a rare but potentially life-threatening condition that can occur after a delivery complicated by infection or trauma.
- Rare diagnoses
- Vaginal foreign body (e.g., a piece of retained suture or other object): Although unlikely, a retained foreign body could cause malodorous discharge and should be considered in the differential diagnosis.
- Vaginal malignancy: Although extremely rare in a 25-year-old woman, vaginal malignancy could present with malodorous discharge and should be considered if other diagnoses are ruled out.