Surgical management of an incarcerated uterus in a gynecological patient: A case report

Nongravid incarcerated uterus with leiomyomas treated with uterine artery embolization and hysterectomy: a case report

Background

The incarcerated uterus in the nongravid patient is rare, and usually is associated with uterine leiomyomas. Leiomyomas may be treated with uterine artery embolization, but the use of embolization has been reportedly rarely in treating nongravid uterine incarceration.

Case

A 50-year-old gravida 2 para 2 woman presented with acute abdominal and flank pain and urinary retention. Her medical history included uterine leiomyomas and nephrolithiasis. Physical examination showed an enlarged uterus (size, 22 weeks). Magnetic resonance imaging showed an incarcerated uterus, complete bladder outlet obstruction, uterine retroflexion and enlargement, and leiomyomas. She was treated with an indwelling Foley catheter, preoperative uterine artery embolization, and total abdominal hysterectomy.

Conclusion

Preoperative uterine artery embolization may be a useful adjunct to hysterectomy in the treatment of the nongravid incarcerated uterus associated with leiomyomas in women who have completed family planning.

Uterine incarceration: a rare diagnosis in non-pregnant women

Uterine incarceration (UI) is a rare complication in non-pregnant women. A woman in her 50s presented to the emergency department with acute urinary retention and paresis of the right inferior limb. A neurological exam suggested a decrease in the right lower limb strength. On gynaecological exam, the cervix was displaced anteriorly and the cul de sac was obliterated with a pelvic mass. CA 19.9 and CA 125 levels were increased. The MRI of the pelvis confirmed an elongated and anteriorly displaced cervix compressing the urethra and the vesical neck due to a uterine mass. A diagnosis of UI was made and an abdominal hysterectomy with adhesiolysis was suggested as the treatment option. Six months after surgery the patient had no urinary complaints and the neurological exam was normal. UI should be considered in women with urinary and neurological symptoms. A delay in diagnosis may lead to significant morbidity.