Case report: incarcerated gestational uterine rectal prolapse managed with manual reduction and Thiersch procedure

Abstract

Introduction and Importance: Incarcerated gestational uterine rectal prolapse is a rare obstetrical complication, with only three other cases reported worldwide. Risk factors for uterine incarceration and anal sphincter deficiency are predisposing factors. The authors report a case of gestational uterine rectal prolapse with successful reduction and prevention, discuss previous approaches and provide recommendations for future cases. Case Presentation: A 33-year-old G5P3 woman presented with a 9 h history of an incarcerated 14-week gestational uterine rectal prolapse, which occurred following a bowel movement. Examination revealed prolapsed rectal lumen containing a gravid uterus with a live fetus demonstrated using point-of-care ultrasound. Under general anesthesia in the left lateral decubitus position, the prolapse was successfully reduced manually and the anal sphincter was secured with a Thiersch perianal encirclement procedure. The pregnancy remained uncomplicated, and she delivered a viable infant via Cesarean section at term. Discussion: This case report is unique in that there have only been three other published reports worldwide and we successfully employ the use manual reduction and placement of a Thiersch encirclement in the management of our case. Manual reduction under general anesthesia in the left lateral decubitus position is noninvasive and was shown to optimally manage gestational uterine rectal prolapse. A Thiersch perianal encirclement procedure coupled with aggressive bowel care was shown to be successful at prevention of recurrence of rectal prolapse in pregnancy following reduction. Conclusion: Manual reduction under general anesthesia and Thiersch encirclement is an effective management for incarcerated gestational rectal prolapse.