De Arpita, Tripathi Reva, Jain Abhinav, Rana Safia
Department of Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research, New Delhi, India.
Department of Radiodiagnosis, Hamdard Institute of Medical Sciences and Research, New Delhi, India.
J Midlife Health. 2023 Jan-Mar;14(1):42-45. doi: 10.4103/jmh.jmh_119_22. Epub 2023 Jul 7.
Primary uterine diverticula are a very rare congenital anomaly of the uterus with only 21 reported cases. Even rarer is the occurrence of primary cervical diverticula with only six cases reported so far. This is a unique case of a huge abdominopelvic mass arising from cervical fibroid around an infected cervical diverticulum. A 44 year-old, P4L4 came to the OPD with a eighteen weeks size abdomino-pelvic mass. She had a failed surgery 6 months back, attempted to remove the mass. Magnetic resonance imaging revealed a cervical diverticulum which possibly had a pus collection. Relaparotomy was done. It revealed a huge cervical fibroid with dense adhesions all around the mass. A pan hysterectomy was done. In the postoperative period, she developed high-grade fever owing to the development of a pelvic collection, which had to be drained by dilating the vault sutures. Histopathology report confirmed a cervical fibroid with an infected diverticulum within. Primary uterine or cervical diverticula are a very rare anamoly which possibly arise because of a weakness in the area where the two mullerian ducts fuse. Women with this rare condition may suffer from infertility, fever and pain abdomen, acute abdomen owing to torsion or hemoperitoneum, pregnancy complications, and menorrhagia. Diverticulectomy and cervical/uterine reconstruction can be done on nulliparous women while hysterectomy can be offered to perimenopausal women. To conclude, unless known by the gynecologists, radiologists, and the pathologists, this diagnosis can be easily missed out, leading to multiple preventable complications.
原发性子宫憩室是一种非常罕见的子宫先天性异常，仅有21例报道。原发性宫颈憩室更为罕见，迄今为止仅报道了6例。这是一例独特的病例，巨大的腹盆腔肿块由感染的宫颈憩室周围的宫颈肌瘤引起。一名44岁、孕4产4的女性因18周大小的腹盆腔肿块前来门诊就诊。她6个月前手术失败，当时试图切除该肿块。磁共振成像显示一个宫颈憩室，可能有积脓。于是进行了再次剖腹手术。术中发现一个巨大的宫颈肌瘤，肿块周围有致密粘连。遂行全子宫切除术。术后，她因盆腔积液出现高热，不得不通过扩张穹窿缝线进行引流。组织病理学报告证实为宫颈肌瘤，内部有一个感染的憩室。原发性子宫或宫颈憩室是一种非常罕见的异常情况，可能是由于两条苗勒管融合部位的薄弱所致。患有这种罕见疾病的女性可能会出现不孕、发热和腹痛、因扭转或腹腔内出血导致的急腹症、妊娠并发症以及月经过多。对于未生育的女性可以进行憩室切除术和宫颈/子宫重建，而对于围绝经期女性可以进行子宫切除术。总之，除非妇科医生、放射科医生和病理科医生有所了解，否则很容易漏诊，从而导致多种可预防的并发症。
