Colonoscopy-assisted reposition of the incarcerated uterus in mid-pregnancy: a report of four cases and a literature review

Dierickx, Inge; Holsbeke, C. Van; Mesens, Tinne; Gevers, Annemie; Meylaerts, L; Voets, Willy; Beckers, Erik A.M.; Gyselaers, Wilfried

doi:10.1016/j.ejogrb.2011.05.024

Cited by 41 publications

(27 citation statements)

References 56 publications

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“…However, mediumto-large (> 6 mm in diameter) polyps, polyps displaying high risk features such as multinodularity or central ulceration, or polyps causing lower GI bleeding should likely be removed at an index colonoscopy without deferral until postpartum. Lower endoscopy has been used several times to release an incarcerated, gravid uterus [44] . Sigmoidoscopy should be sufficient to reach this area and relieve the incarceration.…”

Section: Lower Endoscopymentioning

confidence: 99%

Gastrointestinal endoscopy in the pregnant woman

Friedel

Stavropoulos

Iqbal

et al. 2014

WJGE

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About 20000 gastrointestinal endoscopies are performed annually in America in pregnant women. Gastrointestinal endoscopy during pregnancy raises the critical issue of fetal safety in addition to patient safety. Endoscopic medications may be potentially abortifacient or teratogenic. Generally, Food and Drug Administration category B or C drugs should be used for endoscopy. Esophagogastroduodenoscopy (EGD) seems to be relatively safe for both mother and fetus based on two retrospective studies of 83 and 60 pregnant patients. The diagnostic yield is about 95% when EGD is performed for gastrointestinal bleeding. EGD indications during pregnancy include acute gastrointestinal bleeding, dysphagia > 1 wk, or endoscopic therapy. Therapeutic EGD is experimental due to scant data, but should be strongly considered for urgent indications such as active bleeding. One study of 48 sigmoidoscopies performed during pregnancy showed relatively favorable fetal outcomes, rare bad fetal outcomes, and bad outcomes linked to very sick mothers. Sigmoidoscopy should be strongly considered for strong indications, including significant acute lower gastrointestinal bleeding, chronic diarrhea, distal colonic stricture, suspected inflammatory bowel disease flare, and potential colonic malignancy. Data on colonoscopy during pregnancy are limited. One study of 20 pregnant patients showed rare poor fetal outcomes. Colonoscopy is generally experimental during pregnancy, but can be considered for strong indications: known colonic mass/stricture, active lower gastrointestinal bleeding, or colonoscopic therapy. Endoscopic retrograde cholangiopancreatography (ERCP) entails fetal risks from fetal radiation exposure. ERCP risks to mother and fetus appear to be acceptable when performed for ERCP therapy, as demonstrated by analysis of nearly 350 cases during pregnancy. Justifiable indications include symptomatic or complicated choledocholithiasis, manifested by jaundice, cholangitis, gallstone pancreatitis, or dilated choledochus. ERCP should be performed by an expert endoscopist, with informed consent about fetal radiation risks, minimizing fetal radiation exposure, and using an attending anesthesiologist. Endoscopy is likely most safe during the second trimester of pregnancy.

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Section: Lower Endoscopymentioning

confidence: 99%

Gastrointestinal endoscopy in the pregnant woman

Friedel

Stavropoulos

Iqbal

et al. 2014

WJGE

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“…Additionally, air insufflations with the formation of a loop can have a synergistic effect by creating anterior pressure through the rectal wall on the uterine fundus. Dierick et al 7 have reported successful reduction by colonoscopic insufflations without complication in three out of four cases they attempted. Laparoscopic reduction of uterine incarceration is an evolving technique where reduction is achieved after pneumoperitoneum is achieved.…”

Section: Discussionmentioning

confidence: 98%

“…MRI can be a useful adjunct in cases of diagnostic uncertainty especially during the late second and third trimesters 6. MRI in patients with uterine incarceration characteristically includes freestanding T-shaped multilayer myometrium on sagittal image, small cleft-like cystic lesion between the bladder and the sacculation on axial images corresponding to the elongated cervix and caudal portion of the uterus 7. Additional findings include an inferiorly displaced fundus below the sacral promontory with the displacement of the vagina to the dorsal spine, displacement of the cervix to the ventral and cephalad position along with asymmetric thickening of the posterior uterine wall because of sacculation 7…”

Section: Discussionmentioning

confidence: 99%

Uterine incarceration in a primigravid retroverted bicornuate uterus

2016

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Uterine incarceration is a rare complication that usually occurs after the first trimester of pregnancy. It leads to increased maternal and/or fetal morbidity and mortality. Risk factors include retroversion of uterus and other pelvic abnormalities. Clinical presentation includes severe abdominal and pelvic pain symptoms. Patients can present with concurrent urinary symptoms due to increasing distortion of adjacent structures from the enlarging uterus. A high clinical suspicion of uterine incarceration is confirmed with ultrasound. More advanced imaging such as MRI can be used as an adjunct to ultrasound imaging. Progression from expectant management to intervention is recommended as soon as possible to prevent complications such as uterine rupture and fetal demise. In subsequent pregnancies, close monitoring with serial ultrasounds is warranted to monitor for recurrence of incarceration which has been reported in a few rare cases.

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“…Chaleur et al (2008) reported two cases of uterine incarceration that were managed with myomectomy in the first trimester suffering from acute urine retention due to severe fibroids. Later, Dierickx reported successful decomposition of the uterus by laparotomy where reduction by colonoscopy failed in one case (Dierickx et al 2011).…”

Section: Discussionmentioning

confidence: 98%