Incarcerated uterine prolapse associated with a cul-de-sac abscess

Incarceration is a rare complication of uterine prolapse and is usually associated with bladder calculi. We report a case of uterine incarceration associated with an abscess in the cul-de-sac.

A 64-year-old woman presented with complaints of vaginal prolapse. Pelvic examination on admission revealed an edematous, prolapsed uterus and eversion of the vagina. The bladder was catheterized, and subsequent attempts to reduce the prolapse were unsuccessful. Conservative treatments were initiated including Trendelenburg positioning, estrogen cream, and moist soaks. Failure to reduce the prolapse under general anesthesia necessitated a vaginal hysterectomy and anteroposterior repair. When the cul-de-sac was entered, there was purulent material draining from an abscess behind the uterus. Postoperatively, the patient received antibiotics for 3 days and was sent home on day 4.

Irreducible uterine prolapse is a rare condition and may be attributed to a narrowed introitus, bladder calculi, or pelvic abscesses. Historically, conservative management has attempted to alleviate the edema and restore the prolapse, to allow definitive surgery at a later date. We believe that the pelvic abscess in our case exemplifies a danger of delaying surgery. We recommended that when the patient is in stable condition, a hysterectomy and plastic repair be performed promptly.