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A prolapsed gravid uterus through a broken incisional hernia scar: A case report
Hazem Alouani1, Ghazi Lâamiri1, Jasser Rchidi1
1Department of General Surgery, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia.
Introduction And Importance:
Herniation of the gravid uterus through a previous surgical scar is an extremely rare and high-risk obstetric complication. It can lead to uterine rupture, intrauterine fetal demise, or skin necrosis. Early diagnosis and timely intervention are essential to prevent severe maternal and fetal outcomes.
Case Presentation:
A 28-year-old woman at 32 weeks of gestation presented with a prolapsed gravid uterus through a cesarean section incisional hernia. Examination revealed a large hernia sac with necrotic skin and visible uterine tissue. After stabilization, the uterus was manually reduced, necrotic skin excised, and the abdominal wall was repaired using interrupted sutures. A suction drain was placed, and the wound was closed in layers. Postoperative recovery was uneventful, and the patient delivered a healthy baby at term via cesarean section.
Clinical Discussion:
Herniation of the gravid uterus through an incisional hernia is extremely rare and may be complicated by uterine dehiscence, incarceration, or skin ulceration. Management depends on gestational age and complication severity. While conservative monitoring may be suitable in uncomplicated cases, surgical intervention is warranted when complications arise. Early recognition and appropriate surgical repair are crucial to prevent maternal and fetal morbidity.
Conclusion:
This case highlights the importance of early recognition and prompt surgical management of a complicated gravid uterus herniation through a cesarean scar to ensure favorable maternal and fetal outcomes.
