Case report: Incarceration of the gravid uterus: a radiologic and obstetric challenge

Abstract

We will present the fourth case in the English-language literature of a mid-gestational colonoscopy-assisted manual reposition of an incarcerated uterus. Despite the ready availability of ultrasound, a great number of incarcerations are not recognized before term. Since early diagnosis is the key to a successful treatment, it is important that providers acquire prompt knowledge of this obstetric disorder. Magnetic Resonance Imaging has an important additional value to ultrasound in the detailed scanning of this potentially perilous condition.

Uterine Incarceration: A Case Study

“…Some case reports have described vaginal bleeding and gastrointestinal symptoms such as constipation and tenesmus . Differential diagnoses include ectopic pregnancy, adnexal torsion, appendiceal abscess, posterior fibroid, uterus didelphys, unconnected rudimentary horn, a pelvic or adnexal mass extending into the cul‐de‐sac, gallstones, renal stones, and musculoskeletal pain …”

“…In rare cases, the uterus remains retroverted and the uterine fundus becomes lodged below the sacral promontory as it grows. Risk factors that prevent the fundus from ascending out of the pelvis include the following: adhesions from previous pelvic surgery, pelvic inflammatory disease or endometriosis, large fibroids, uterine malformation, uterine prolapse, and deep sacral concavity . In these cases, the uterus continues growing but remains trapped in the pelvis.…”

Successful vaginal delivery at term following ventro-fixation procedure for uterine incarceration

“…Dierickx reported a case of uterus incarceration in a primigravida, in which, after combined recto-vaginal manipulation failure, a colonoscopy-assisted manipulation restored the polarity. The manoeuvre was followed by a term uncomplicated vaginal delivery (Dierickx et al 2014). Therefore, the appropriate technique, which provides and sustains normal uterine anatomy, also gives the advantage of spontaneous vaginal delivery.…”

Spontaneous reduction of an incarcerated gravid uterus in the third trimester

“…Furthermore, a common physical finding is a fundal height that is smaller than expected for the gestational age [1-3, 5, 6]. Therefore, if an incarcerated uterus is diagnosed before around 20 weeks of gestation, passive reduction in which the patient assumes the knee-chest position after urination is considered first, followed by manual reduction, and then endoscopic or laparoscopic reduction [2,9,10,[16][17][18]. However, some reports do not recommend reduction after 20 weeks of gestation because of a low success rate and the possibility of serious complications associated with reduction, such as miscarriage, preterm delivery, and uterine rupture [2,7,19,20].…”