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OBSTETRIC IMAGING Table of Contents   
Year : 2004  |  Volume : 14  |  Issue : 4  |  Page : 433-434
Gravid uterus : A rare case


Department of Radiodiagnosis and Obst & Gynae, M.L.B. Medical College, Jhansi(U.P.)., India

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Keywords: Vesical Calculus, Obstructed Labour, Ruptured gravid uterus.

How to cite this article:
Kumar A G, Sharma S, Singh H, Singh S. Gravid uterus : A rare case. Indian J Radiol Imaging 2004;14:433-4

How to cite this URL:
Kumar A G, Sharma S, Singh H, Singh S. Gravid uterus : A rare case. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Sep 20];14:433-4. Available from: http://www.ijri.org/text.asp?2004/14/4/433/28690

   Introduction Top


We are reporting a rare case of large vesical calculus leading to obstructed labour and rupture of gravid uterus in a 23 year old rural woman to emphasize the need of investigations in patients with urinary system complaints in antenatal period.


   Case report Top


An unbooked, 23 year old primigravida of rural area was admitted in the emergency ward with complaints of nine months amenorrhoea, severe lower abdominal pain and bleeding per vaginum for last twenty four hours. She also gave history of increased frequency, burning micturition and often difficulty in passing urine even before pregnancy and during antenatal period. She had no history of hematuria. She had no antenatal visits. She was never investigated for urinary system complaints.

Her vitals on admission were - pallor++, P/R -124 and BP- 80mm Hg systolic. Abdominal examination revealed a tense and tender abdomen with ill defined uterine outline. Fetal heart sounds were absent. Vaginal examination revealed cervix dilated to about six cm. Fetal head could not be made out, but a hard mass was palpated through the anterior vaginal fornix. Hemoglobin was 7.0 gm/dl. Blood group was B positive. Other investigations were within normal limits. Ultrasound examination could not be performed due to non-availability of this facility in the emergency department.

Considering rupture of uterus, emergency laparotomy was done under general anaesthesia. The uterus was found ruptured in lower uterine segment and extending to left broad ligament. The baby was found dead and lying in peritoneal cavity. There was large amount of blood in peritoneal cavity. Baby was taken out, blood removed and uterus was repaired. Urinary bladder was edematous and hard on palpation. Obstetrician could not understand the cause of hardness of urinary bladder. Considering the low general condition of the patient, urinary bladder was not opened and abdomen was closed. Post-operative period was un-eventful.

Considering per operative findings of the urinary bladder, patient was referred to radiodiagnosis department for further investigation. Pelvic radiograph was taken which showed a large laminated vesical calculus measuring about 10X8cm size [Figure - 1]. Patient further referred to surgery department. When the patient's general condition became stable she was operated and a large vesical calculus was removed from urinary bladder. The post operative period was un-eventful.


   Discussion Top


The largest vesical calculus weighing 6 kg has been reported by David Sutton 1. Large vesical calculus can cause difficulty during labour. Gadappa SN et al (2002), reported a case of obstructed labour due to vesical calculus, but without rupture of uterus2. To the best of our knowledge, rupture of gravid uterus due to vesical calculus has not been reported in the literature, so far. Most of the vesical calculi are radio opaque and can be readily demonstrated by plain radiograph of abdomen but X-rays are not indicated during pregnancy. US scanning is a safe and non invasive tool to detect vesical calculus specially in antenatal period.

Therefore, such a complication can be avoided if the treating clinician pays proper attention to the urinary symptoms and asks for simple investigations like US examination during antenatal period.[2]

 
   References Top

1.Sutton D. Murfitt J. Text book of radiology, 6th ed Edinburgh. Churchill Livingstone, 1998;1167.  Back to cited text no. 1    
2.Gadappa SN, Bichile LK, Yelikar KA et al. Obstructed labour due to vesical calculus. J. of Obst and Gyn of India 2002; 52(5):63.  Back to cited text no. 2    

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Correspondence Address:
A G Kumar
Department of Radiodiagnosis, M.L.B. Medical College, Jhansi.
India
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Source of Support: None, Conflict of Interest: None


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