Case Report
Use of MRI for Evaluation of Retained Uterine Fundus Mimicking a Pelvic Mass

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Abstract

Increased use of less invasive hysterectomy techniques requires awareness of the unique potential complications they pose in patients with continued symptoms after surgery. Retained uterine fundus is rare after vaginal hysterectomy; only 2 other cases have been reported in the English literature. Magnetic resonance imaging (MRI) was not used preoperatively in either case. However, imaging evaluation, in particular with MRI because of its superior soft tissue resolution, can be helpful in suggesting the diagnosis. Herein is presented the case of a 40-year-old woman who had undergone vaginal hysterectomy several years previously, but was experiencing abdominal pain. MRI was performed, which revealed a supravesical mass. Visualization at MRI of intact round ligaments arising from the mass favored the diagnosis of retained uterine fundus and confirmed after surgical excision.

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Case Report

A 40-year-old morbidly obese woman (body mass index of 50) had right lower quadrant pain. Pertinent surgical history included 2 cesarean deliveries, and a vaginal hysterectomy without oophorectomy, performed at another institution several years previously because of symptomatic uterine leiomyomas. Physical examination demonstrated tenderness to palpation in the lower abdomen, most pronounced in the right lower quadrant. There were no palpable masses. Computed tomography of the abdomen and

Discussion

Second to cesarean delivery, hysterectomy is the most frequently performed surgical procedure in women of reproductive age. Approximately 600 000 such procedures are performed each year. The 2009 Cochrane Review assessed the most beneficial surgical approach to hysterectomy to treat benign disease. Compared with abdominal hysterectomy, vaginal hysterectomy was more beneficial because it is substantially less invasive. If vaginal hysterectomy is not possible, laparoscopic hysterectomy can be

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