A 13-year-old female presented in the ED with severe abdominal pain. No proper history is available, but patient did have surgery in pelvis. CT scan with I/V contrast was performed.
Clinical History: A 13-year-old female patient presented in the emergency department with severe abdominal pain. No proper history is available, but patient did have surgery in pelvis. On request of clinician CT scan with I/V contrast was performed.
Figure 1. Sagital image from plain CT showing dilated vagina with calculi.
Figure 2. Sagital image from plain CT showing dilated vagina with calculi.
Figure 3. Coronal image from contrast CT showing dilated uterus superior to urinary bladder.
Figure 4. Axial image from contrast CT showing dilated vagina with calculi posterior to urinary bladder.
Contrast CT scan findings: The vagina and uterus appear dilated and fluid filled. Multiple calculi are seen in the vagina. The dilated vagina is displacing the urinary bladder superiorly and compressing the rectum posterior. Surgical metallic staple is seen for pubic symphysis denoting previous surgery.
Discussion: Primary vaginal calculi are due to urinary leak into the vagina through various types of fistulae and are associated with vaginal obstruction and urinary stasis.  In the absence of obstruction and stasis of urine in the vagina, infection with urease-splitting bacteria alone, is also cited as an etiological factor for stone formation. 
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Sikander Ali Khan, MD, consultant radiologist, Royal Commission Medical Center, Saudi Arabia