When prolapse cannot be reduced: incarcerated procidentia due to pelvic mass

Area of Science:

• Gynecologic Surgery
• Urogynecology
• Pelvic Organ Prolapse

Background:

• Incarcerated procidentia, a rare complication of pelvic organ prolapse, can present with significant challenges.
• Pelvic masses are an uncommon but critical cause of obstructed ureters in procidentia.

Observation:

• A 61-year-old woman presented with complete procidentia and symptoms of urinary obstruction.
• Imaging revealed a large pelvic mass (11.5 cm) within the prolapse, causing bilateral ureteral obstruction and hydronephrosis.
• Initial attempts at manual reduction of the prolapse were unsuccessful.

Findings:

• A posterior colpotomy was performed to access and dissect the pelvic mass, identified as uterine fibroids and a mature cystic teratoma.
• Mass removal allowed for successful reduction of the procidentia.
• Robotic hysterectomy was subsequently performed.

Implications:

• This case highlights a surgical approach for incarcerated procidentia secondary to pelvic masses.
• Colpotomy is a viable technique for mass removal, facilitating prolapse reduction and alleviating ureteral obstruction.
• Prompt surgical intervention is crucial for managing complex cases of incarcerated procidentia with pelvic masses.