Uterine Sacculation of Di-Di Twin pregnancy [24O]

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Abstract

INTRODUCTION:

Uterine sacculation is a rare complication of pregnancy. It may cause substantial peri-partum morbidity including pain and rarely uterine rupture. It consists of a transitory out-pouching or sac-like structure developing from an abnormal forward or backward rotation of the uterine fundus.

METHODS:

A 36 year old female with past medical history significant for Crohn’s disease, total proctocolectomy, and resolved cervical prolapse who presented at 16 weeks gestation with severe pelvic pain and intermittent urinary retention. Physical exam and confirmatory MRI revealed the suspected diagnosis of uterine incarceration. Initially there was temporary improvement with exam under anesthesia and bimanual exam to dis-impact the uterus. Repeat attempts at bimanual exam had no success. Out of concern for thick pelvic adhesions inhibiting uterine mobility and the risk of uterine rupture the patient was taken for minimally invasive surgery.

RESULTS:

After a diagnostic laparoscopy, and thorough uterine manipulation using a single hand gel port the uterus was confirmed to not be truly incarcerated, rather to have a posterior uterine sacculation likely leading to the extreme pain. Post op course was complicated by prolonged and excessive pain symptoms. PMNR specialists were brought in to assist with management for the duration of this painful pregnancy and to assist with prevention of the unfortunate sequela of prolonged opiate use. The patient ultimately also sought out non-western modalities of pain management.

CONCLUSION:

Diagnosis of uterine sacculation can be difficult. Patients can present with symptoms mimicking incarceration, including severe pain and urinary retention. There is a reported minimal risk of uterine rupture.

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