Division of Female Pelvic Medicine and Reconstructive Surgery, University of Louisville Department of Ob/Gyn and Women's Health, 2nd floor, Chair's Suite, 550 S. Jackson Street, Louisville, KY, 40202, USA.
Division of Gynecologic Oncology, University of Louisville Department of Ob/Gyn and Women's Health, 2nd floor, Chair's Suite, 550 S. Jackson Street, Louisville, KY, 40202, USA.
Int Urogynecol J. 2022 Jul;33(7):2053-2055. doi: 10.1007/s00192-022-05175-9. Epub 2022 Apr 4.
Our objective is to demonstrate a surgical approach to the treatment of incarcerated procidentia with obstructed ureters due to a pelvic mass.
A 61-year-old woman presented with constipation, vaginal swelling, and difficulty voiding. On examination she had complete procidentia, which could not be reduced with gentle pressure. On imaging the prolapse appeared to contain a large pelvic mass measuring 11.5 cm in its greatest diameter, with features consistent with a mature teratoma. She was also noted to have bilateral ureteral obstruction and prominent hydronephrosis. After unsuccessful prolapse reduction under anesthesia, Bovie electrocautery was used to perform a posterior colpotomy. The obstructing mass was dissected away from the uterus and its connecting pedicle transected. The prolapse could then be reduced and a robotic hysterectomy performed.
Pathology showed multiple pelvic masses including an 8-cm necrotic cystic nodule most consistent with uterine fibroids and a 4.5-cm mature cystic teratoma with associated seromucinous cystadenoma of the left ovary. Bilateral nephrostomy tubes were placed postoperatively.
Incarcerated procidentia is an uncommon occurrence, which in rare cases may be due to a pelvic mass. Surgical management may be required with colpotomy for removal of the pelvic mass in order to reduce the prolapse and resolve the case.
我们的目标是展示一种手术方法，用于治疗由于盆腔肿块而导致的嵌顿性脱垂并伴有输尿管梗阻的病例。
一名 61 岁女性因便秘、阴道肿胀和排尿困难就诊。检查时发现完全性脱垂，经轻柔按压无法复位。影像学检查显示脱垂物内似乎有一个直径为 11.5 厘米的大型盆腔肿块，其特征与成熟畸胎瘤一致。此外，患者还存在双侧输尿管梗阻和明显的肾盂积水。在全身麻醉下脱垂复位失败后，使用 Bovie 电烙术进行后阴道切开术。从子宫上解剖并切断阻塞性肿块及其连接的蒂。然后可以将脱垂物复位并进行机器人子宫切除术。
病理检查显示多个盆腔肿块，包括一个 8 厘米的坏死囊性结节，最符合子宫肌瘤；以及一个 4.5 厘米的成熟囊性畸胎瘤，伴左侧卵巢的浆液粘液性囊腺瘤。术后双侧放置了肾造口管。
嵌顿性脱垂并不常见，在极少数情况下可能是由于盆腔肿块引起的。可能需要手术治疗，通过阴道切开术切除盆腔肿块以减轻脱垂并解决该病例。
