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Incarcerated Procidentia: A Rare Complication of Carcinoma Cervix
Author(s) -
Kriplani Alka,
Relan Supriya,
Kumar Lalit,
Biswal B. M.,
Rath G. K.
Publication year - 1995
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1995.tb02170.x
Subject(s) - cervix , medicine , complication , cervix carcinoma , carcinoma , general surgery , gynecology , surgery , cervical carcinoma , cancer , cervical cancer
EDITORIAL COMMENT: The word incarcerated is defined as imprisoned; in pregnancy an incarcerated uterus is one imprisoned in the pelvis usually as a result of retroversion with presentation caused by acute retention of urine due to obstruction of the urethra. Irreducible is a more appropriate term to apply to a procidentia than incarcerated in our opinion. Rarely a procidentia is truly irreducible although a longstanding prolapse with ulceration and oedema may at first seem to be irreducible until the enterocele is progressively replaced ‐ the inexperienced practitioner may fail to replace such a prolapse if an attempt is made to reduce the anterior wall first. The anterior vaginal wall prolapses first followed by the cervix then enterocele and rectocele, and correction requires the same technique in reverse; i.e. the posterior aspect of the mass must be reduced first to correct the enterocele before the cervix and cystocele can be replaced into the vagina as is performed prior to preparation for surgery or rarely, insertion of a pessary when surgery is refused by either the patient or the anaesthetist. The editor has seen only one woman with an irreducible procidentia and in this case it had been present for many years and was extremely keratinized. We accepted the present case for publication because of its rare anecdotal interest and the excuse it provided for reminding readers how to replace a huge prolapse. It may be noted that the term procidentia means prolapse (Latin procedure: to fall forward) but it is often used as being indicative of third degree or massive prolapse. It would have been of interest to know the renal function in this woman. The case also illustrates how radiation can shrink a tumour and allow subsequent revision of treatment options when the woman does not abscond. Summary: A rare case of a huge carcinoma of the cervix leading to sudden uterovaginal prolapse and incarcerated procidentia, in a postmenopausal woman is presented. The woman presented as an emergency with severe distress. The problem was successfully managed by reducing the uterovaginal prolapse under deep sedation and starting radiotherapy as an emergency procedure at the same sitting. The role of immediate radiotherapy in the management of such an emergency situation is discussed.