An unusual case of traumatic primary amenorrhoea

Laparoscopic cervico-isthmic anastomosis for old traumatic disjunction between the cervix and the uterine corpus: a case report and literature review

BACKGROUND

Old traumatic disjunction between the cervix and the uterine corpus is very rare case. In most cases, it is not immediately noticed until the onset of other symptoms, such as amenorrhea, periodic abdominal pain and so on. Scanty cases of anastomosis surgery via laparoscope have been reported.

CASE PRESENTATION

We report here a 23-year-old young woman with the primary amenorrhea due to traumatic cervico-isthmic disjunction. The patient had a closed pelvic fracture at the age of 4 and has experienced periodic lower abdominal pain since the age of 17 years. A complete disjunction between the cervix and the uterine corpus was diagnosed. Laparoscopic cervico-isthmic anastomosis was performed to restore the continuity of the endometrial cavity and cervical canal. After this surgery, normal menstruation was resumed without cyclic abdominal pain.

CONCLUSION

Laparoscopic cervico-isthmic anastomosis could reconstruct the uterine outflow tract successfully, alleviate symptoms, and achieve a good short-term outcome.

Immediate Repair of a Complete Uterine Transection After Motor Vehicle Collision

BACKGROUND

Traumatic separation of the cervix from the uterine corpus is rare. We describe a case in which this injury was identified and surgically repaired at initial presentation to preserve fertility.

CASE

An 18-year-old woman presented with a pelvic crush injury after a motor vehicle accident. Imaging revealed pelvic fractures and bladder rupture. Complete transection of the uterine corpus at the level of the internal os was identified at laparotomy. The gynecology service was consulted and circumferentially reattached the corpus to the cervix.

CONCLUSION

Uterine integrity should be confirmed in female patients with pelvic crush injuries who undergo exploratory laparotomy given the unknown extent of intra-abdominal trauma. Immediate surgical correction of uterine transection at the time of injury with restoration of the genital outflow tract is feasible and may allow preservation of fertility.

About a case of traumatic separation of the cervix from the uterine corpus, diagnosed in a context of infertility

This article reports a case of cervico-isthmic disjunction unnoticed during childhood, diagnosed in a context of primary infertility and endometriosis, and surgically treated. It is an uncommon condition. The diagnosis is most often made as part of an assessment of primary amenorrhea in a young woman with a history of severe pelvic trauma. It is suspected after imaging assessment and confirmed intraoperatively. The treatment consists in an anastomosis between the cervix and the uterine body, after individualizing these two structures, around a drain guiding healing. After this surgery, multiple pregnancies have been successfully carried out.

Pregnancy outcomes after pelvic ring injury

OBJECTIVES

Previous studies reported negative effects of pelvic trauma on genitourinary and reproductive function with frequent cesarean delivery. Risk factors for cesarean delivery have not been well defined. The purpose of this project was to evaluate outcomes of pregnancy after pelvic ring injury. We hypothesized that cesarean delivery would be more frequent after pelvic fracture with potential causes including patient and physician preference, malunion, and retained hardware.

DESIGN

Retrospective review with prospective collection of obstetric information.

SETTING

Level I trauma center.

PATIENTS/PARTICIPANTS

Thirty-one women, 16 to 40 years old, with pregnancy after healed pelvic fracture.

INTERVENTION

Orthopaedic Trauma Association (OTA) classification included 10 B-type and 21 C-type fractures, 17 (55%) of which were treated surgically.

MAIN OUTCOME MEASUREMENTS

Obstetric questionnaires were obtained for 54 pregnancies after a mean 72 months follow-up.

RESULTS

Sixteen women had 25 vaginal deliveries; 28% after surgical treatment for their pelvic fracture with retained anterior (16%) and/or posterior (16%) hardware, including transsymphyseal plating in three patients (12%). Thirteen women had 26 cesarean deliveries, 46% after surgical treatment for their pelvis. The new cesarean delivery rate was 44% versus 17% preinjury (P = 0.02). Two had cesarean deliveries as repeat procedures after preinjury cesarean delivery. Four had cesarean deliveries as a result of medical complications (pre-eclampsia, n = 2; breech, n = 1; labor arrest, n = 2). Seven women (54%) reported 12 cesarean deliveries (46%) resulting from pelvic fracture; three elected cesarean delivery despite their physician offering a trial of labor, whereas four were advised by their obstetrician. Cesarean delivery was not related to age, fracture pattern, treatment type, or residual pelvic displacement. A trend for cesarean delivery related to retained hardware was observed (P = 0.06).

CONCLUSIONS

Uncomplicated pregnancies and deliveries are possible after pelvic fracture. The new cesarean delivery rate among these women is significantly increased with over half related to patient and obstetrical preferences. Fracture pattern, minor malalignment, and retained hardware are not absolute indications for cesarean delivery. Neither surgical care of the pelvis or retained fixation precludes successful vaginal delivery. Development of guidelines and objective indications for trial of normal labor after pelvic fracture is needed.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Uterine rupture following a road traffic accident

A nulligravida presented in traumatic shock and suffered pelvic trauma, including an absolute uterine rupture at the isthmus. Her uterus was reconstructed by reconnecting the uterine corpus with the cervix in an emergency surgery. Two years later, the patient became pregnant without any assisted technology.

Secondary amenorrhea resulting from traumatic separation of the cervix from the uterine corpus

BACKGROUND

Amenorrhea resulting from crushing trauma of the pelvis is exceptionally rare. The purpose of this case report is to describe the diagnosis of and successful surgical correction of traumatic separation of the cervix from the uterine corpus.

CASE

A nulligravida presented with a complaint of secondary amenorrhea after a motor vehicle accident in which she sustained a crush-type injury to the pelvis. Ultrasonography and laparotomy revealed a complete separation of the uterine corpus from the cervix. The uterine corpus was approximated to the cervix with circumferentially placed sutures to establish a patent outflow tract from the endometrial cavity to the cervical canal.

CONCLUSION

This case demonstrates the successful surgical correction of secondary amenorrhea resulting from traumatic separation of the uterine corpus from the cervix. Normal menstruation resumed 6 weeks after surgery.