Non-Puerperal Uterine Inversion Secondary to Submucous Uterine Fibroid: Surgical Management and Outcome Using a Combined Abdominal and Vaginal Approach

Abstract

Background: Non-puerperal uterine inversion (NPUI) is undoubtedly a rare phenomenon, in which, if an early diagnosis is to be made, a clinician must have a high index of suspicion. It is also important to be familiar with the different surgical techniques involved in its management. This report gives an account of a case of NPUI managed by a combined abdominal and vaginal approach. Case Presentation: The patient was a 39-year-old woman whose last childbirth was 7 years ago. She presented with heavy menstrual bleeding of a year duration and watery, copious, and foul-smelling vaginal discharge of 7 days duration. On examination, the inverted uterus was found to be protruding from the introitus with a solitary gangrenous fibroid mass attached to its fundal region. An excision of the mass was done via a vaginal approach with subsequent failed attempts to revert the uterus. Thus, the uterus was amputated per vagina, and its appendages approached per abdomen. The histology report revealed gangrenous leiomyoma with no evidence of malignancy. Conclusion: A high index of suspicion, appropriate history with astute pelvic examination and appropriate investigations are all important in the diagnosis and management of uterine inversion. Pelvic ultrasonography, especially those with Doppler enhancement, together with magnetic resonance imaging, have characteristic features. Definitive treatment involves reverting the uterus to its normal position and either preserving fertility or performing a hysterectomy if the family size is complete.