Incarceration of a bicornuate retroverted gravid uterus presenting with bilateral uretric obstruction


Dear Sir,

There are a number of points raised in the Case Report by Keating et al. (1992) that deserve mention.

They do not state the mode of anaesthesia administered to the patient. Given that the caesarean section was elective, in the sense that it did not necessitate a crash general anaesthetic, then surely an epidural would have been safer for the patient, but more to the point, would have enabled the surgeon/s to discuss the findings with the very young woman they were about to hysterectomize.

Assuming that the principal operating surgeon was a consultant (and if not, why not?), then why proceed to hysterectomy at all? I understand from the tenor of the letter they rightly discovered the acute retroversion intra-operatively and hence were able to delineate the surgical incisions made. That being the case I cannot see any reason to doubt‘the integrity of the suture lines.’Any operating surgeon familiar with pelvic anatomy and the principles of healing will know well how quickly the female pelvis tolerates such insults on the path to full and normal recovery.

There was a pelvic mass, granted, but given the gravity of the surgery subsequently performed then surely a biopsy, or even a frozen section, with possible recourse to a laparotomy as an interval, would have been the most appropriate management. Malignant uterine causes of the findings in this age group are very rare indeed.

As it now stands a 19-year-old woman has been hysterectomized for an uncommon, but totally benign condition, with the high probability of a premature menopause given the loss of the ascending branches of the uterine arteries that are a vital part of ovarian blood supply.