Gravid Uterine Herniation in Ventral Wall Defect: A Rare Cause of Pelvic Pain

Abstract

Pelvic pain in women represents one of the most frequent yet diagnostically challenging symptoms encountered in clinical practice. Its etiology encompasses a wide range of gynecologic, urologic, gastrointestinal, musculoskeletal, neurological, and even psychological origins. Common causes include endometriosis, fibroids, interstitial cystitis, inflammatory bowel disease, and myofascial pain syndromes. However, herniation of a gravid uterus through a ventral wall defect remains exceedingly rare and is associated with serious maternal and fetal risks. We present a unique case of a 35-year-old multiparous woman who developed pelvic pain secondary to herniation of the gravid uterus through a previous infraumbilical incisional hernia at 18 weeks’ gestation. Diagnosis was confirmed by ultrasound and MRI. Manual reduction under spinal anesthesia was successfully performed, followed by conservative management and elective cesarean delivery with mesh repair at 35 weeks. This case highlights the importance of clinical vigilance, timely imaging, and multidisciplinary management to ensure favorable maternal and fetal outcomes in such rare presentations.