Minimally Invasive Surgery for Persistent Uterine Incarceration in a Patient with a History of Prior Colectomy

Abstract

<h3>Study Objective</h3> 1. Review the diagnosis, risk factors and management options for the incarcerated gravid uterus. 2. Present a case of an incarcerated uterus at 18 weeks gestation which resulted in acute urinary retention and was able to be resolved with minimally invasive surgery after initial noninvasive methods failed. 3. Discuss the management of the incarcerated uterus including the role of minimally invasive surgery and specific suggestions which may be helpful. <h3>Design</h3> Case presentation. <h3>Setting</h3> Operating room at a tertiary academic medical center. <h3>Patients or Participants</h3> A 25-year-old gravida 2 para 0 at 18 weeks gestation with symptomatic and persistent uterine incarceration causing urinary retention. This patient also had a history of prior laparoscopic colectomy for inflammatory bowel disease. <h3>Interventions</h3> Laparoscopic and vaginal approach to reducing uterine incarceration under general anesthesia. <h3>Measurements and Main Results</h3> Resolution of uterine incarceration and urinary retention as well as favorable pregnancy outcome. <h3>Conclusion</h3> The incarcerated gravid uterus is an uncommon but potentially severe complication of pregnancy with risks to the mother and fetus. It can be confirmed on imaging and a stepwise approach to reduction can be employed to minimize invasive interventions. We present a combined laparoscopic and vaginal approach which successfully reduced a case of persistent incarcerated uterus at 18 weeks gestation and resolved urinary retention. Additionally, we suggest history of prior total colectomy as an additional risk factor for this condition as the absence of a mobile rectum in the pelvis may contribute to incarceration of the uterus.