Traumatic transection of the uterus: missed, diagnosed, and repaired-a case report and review of literature.

backgroundUterine transection is a very rare result of pelvic trauma, with less than a dozen case reports in the literature. The reporting radiologist's unfamiliarity with this injury led to a missed diagnosis on ultrasound, as well as on magnetic resonance imaging. This led to delayed treatment. We hope that with this publication, a wider audience will consider this possibility in the appropriate clinical and imaging setting. CASE PRESENTATION: We report the case of a 25-year-old South Asian woman with primary amenorrhea, mild irregular spotting, severe monthly pain, and primary infertility, who had uterine transection. She sustained trauma at the age of 2 years. She was worked-up for infertility, including ultrasound and magnetic resonance imaging; however, the radiologist's reports were erroneous. On the final ultrasound, and later on magnetic resonance imaging, the cervix with an open internal os was seen lying separate from the corpus. Hematometra and hemoperitoneum were also noted, and a diagnosis of transection of the uterus was made. At surgery, a uterine transection, as suggested by imaging, was found. The two separated components of the uterus were aligned and anastomosed. The patient, since her repair has had two menstruation cycles, on time and pain free.

conclusionThe rarity of the condition and unfamiliarity with the pathology caused the initial misdiagnosis. If the injury remains undiagnosed it causes infertility, severe amenorrhea and/or dysmenorrhea, and a markedly impaired quality of life. The injury once diagnosed is easily repaired and often results in the return of menstruation and, sometimes, even fertility.