Management of Acute Urinary Retention due to Bladder Outlet Obstruction in the Setting of Incarcerated Gravid Uterus

An incarcerated gravid uterus (IGU) is a rare condition that occurs when a retroverted gravid uterus becomes trapped between the sacral promontory and pubic symphysis. If untreated, IGU could have devastating consequences including uremia, renal failure, sepsis, peritonitis, uterine wall necrosis/rupture, and ultimately maternal and/or fetal death. Our objective is to provide education on the presentation, diagnosis, and management of a rare diagnosis to assist clinicians in better recognizing and treating IGU.

We present two cases of gravid females with acute urinary retention (AUR) in the setting of IGU. In this case series, we will discuss patient presentation, workup, and management of both IGU and AUR secondary to IGU.

The first patient represents delayed recognition of IGU and a protracted clinical course resulting in increased morbidity. The second case represents heightened recognition of IGU and appropriate, timely management.

Prompt bladder decompression by urethral or suprapubic catheterization is the mainstay treatment for nearly all etiologies of AUR. In the case of AUR due to IGU, it is imperative to address bladder decompression prior to the reduction of IGU.