Colonoscopic release of the incarcerated gravid uterus.

Abstract

Incarceration of the gravid uterus occurs in the early second trimester in approximately one in 3000 pregnancies. If conventional manual attempts at restoring the uterine fundus to the anterior position are unsuccessful, correction by an invasive laparotomy procedure is necessary. We describe a minimally invasive technique to dislodge the incarcerated gravid uterus. Gravid patients with an incarcerated uterus refractory to manual reduction are administered sedation, and one to two enemas. After sedation, manual reduction is attempted again. If unsuccessful, a colonoscope is passed above the level of the uterine fundus generating external anterior forces, which dislodge the uterus from beneath the sacral promontory. The procedure was performed six times in five patients. One patient required a second procedure because of recurrence of the condition. All procedures were successful. No pregnancy losses occurred after the procedure, and no complications of colonoscopy were encountered. Colonoscopic release of the incarcerated gravid uterus is an option when attempts at manual reduction fail. This procedure may avoid laparotomy to correct this condition.