(1559) A Rare Case of Uterine Incarceration in a Post-Menopausal Patient

Introduction: Uterine incarceration is a complication associated with pregnancy occurring after 20 weeks of gestation, that affects less than 0.03% of pregnant persons. It is very uncommon outside of pregnancy with exceedingly few cases being reported, especially in older or post-menopausal persons. It can result in genitourinary complications, infections and renal injury if left untreated. Definitive intervention requires surgical resection or hysterectomy, the extent of which is determined by etiology.

Description: A 57-year-old female was admitted to the ICU with septic shock after presenting with urinary retention, vaginal bleeding and altered mentation. Initial labs were remarkable for acute kidney injury, hyponatremia, acidosis, and likely UTI. CT imaging showed a retroflexed uterus with a large mass and complex endometrial stripe, multiple fibroids, and bladder outlet obstruction secondary to uterine incarceration, resulting in hydronephrosis and marked bladder distention. After hemodynamic stabilization, electrolyte management and initiation of antibiotic therapy, both urology and gynecology were needed to assist in foley insertion for successful bladder decompression due to the complexity of the patient’s anatomy. Subsequent urine culture was positive for E coli. Once stabilized with resolution of hyponatremia and completion of antibiotic therapy, she was able to get surgical resolution with an abdominal hysterectomy.

Discussion: Uterine incarceration develops with the progressive changing anatomy of pregnancy, when the expanding retroverted uterus (found in an estimated 20% of pregnancies) does not spontaneously reposition, resulting in entrapment below the sacral promontory. This principle can arguably be applied to any condition where the retroverted uterus might have cause to expand. Our patient had uterine fibroids and an enlarging mass resulting in similar uterine enlargement. The cause of new or progressing fibroids in the post-menopause period are poorly understood. They are expected to decrease during peri/post-menopause due to decreased hormone production, but cannot be excluded, as in the case of our patient.