A Rare Case of Nonpuerperal Uterine Inversion Managed by a Combined Laparoscopic and Vaginal Approach

Younas, Kinza; Chisholme, Benjamin; Neelankavil, Joshy Joseph; Kevelighan, Euan

doi:10.5005/jp-journals-10006-1656

Cited by 2 publications

(11 citation statements)

References 11 publications

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“…We believe that this report will contribute to the literature by showing the feasibility of the laparoscopically assisted management of non-puerperal inversion. On the other hand, there were five previous cases of non-puerperal uterine inversion that were managed by a laparoscopic approach (Table 2) [9][10][11][12][13]. The expulsion of submucosal leiomyoma was found to be the cause in all cases.…”

Section: Discussionmentioning

confidence: 93%

A Rare Case Report of Successful Laparoscopy-Guided Reduction of Non-Puerperal Uterine Inversion

2023

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Non-puerperal uterine inversion is an extremely rare and potentially dangerous condition. Cases are poorly described in the literature, and their actual incidence is unknown. A 34-year-old nulliparous female patient visited the emergency department following a loss of consciousness. She had experienced continuous vaginal bleeding over the preceding two months, with a two-day history of worsening symptoms. The patient showed signs of hypovolemic shock secondary to unceasing vaginal bleeding. Ultrasound and computed tomography revealed an inverted uterus and a large hematoma inside the patient’s vaginal cavity. An emergency explorative laparoscopy was performed, which confirmed uterine inversion. Initially, Johnson’s maneuver was attempted under laparoscopic visualization, but this failed to achieve uterine reduction. Following the unsuccessful performance of Huntington’s maneuver, a re-trial of the manual reduction allowed the uterus to recover to its normal anatomy. The patient’s vaginal bleeding was dramatically reduced after successful uterine reduction. The pathologic report conducted confirmed endometrioid adenocarcinoma. Laparoscopic visualization is a feasible and safe procedure for achieving uterine reduction in cases of non-puerperal uterine inversion with an unconfirmed pathology. Uterine malignancies should be considered in patients with non-puerperal uterine inversion.

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Section: Discussionmentioning

confidence: 93%

A Rare Case Report of Successful Laparoscopy-Guided Reduction of Non-Puerperal Uterine Inversion

2023

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“…1,[3][4][5] Fundal fibroids due to their traction effect have an increased risk. 1,3,6 Majority of non puerperal uterine inversion presents after 45 years and is mostly benign. Only 20% of pathologic specimens showed malignancy which were usually seen among young women.…”

Section: Discussionmentioning

confidence: 99%

“…Only 20% of pathologic specimens showed malignancy which were usually seen among young women. [4][5][6] Hence in women of reproductive age, malignancy is always a suspicion if uterine inversion occurs. This stresses on the need of histopathology specially to manage local recurrence or distant metastasis that may occur many years after the initial surgery.…”

Section: Discussionmentioning

confidence: 99%

“…However clinical findings of a mass coming through the vagina (stage 3 or 4) without definite margins of a cervix and a nonpalpable uterus on bimanual or rectal examination can aid in the diagnosis. [4][5][6] The diagnosis of inversion may be difficult to make during examination especially with sloughed endometrium when it may be confused with fibroid polyp. The misdiagnosis of submucous fibroid and surgical attempt to remove it vaginally may result in profuse bleeding and fundal perforation of the uterus.…”

Section: Discussionmentioning

confidence: 99%

“…4 Most cases are managed by abdominal or vaginal hysterectomy after repositioning the uterus. 6 Although conservative surgery is preferred among women who wish to preserve fertility, radical hysterectomy is recommended in malignant cases. 4 We report a rare case of non-puerperal complete uterine inversion in nulliparous virgin female and its management.…”

Section: Incidence Of Puerperal Uterine Inversion 1 In 20000mentioning

confidence: 99%

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A rare case of acute non puerperal complete uterine inversion in nulliparous virgin female

Bhangale¹,

Kumar²,

Sharma³

et al. 2023

Int J Reprod Contracept Obstet Gynecol

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Non-puerperal uterine inversion (NPUI) is extremely rare and accounts for 17% of all uterine inversion cases. A few more than 150 cases have been reported amongst which 10-15 have been reported in nulliparous females and 3-4 have been reported in virgin females from 1914 till date. A 40 years unmarried nulliparous female denying sexual activity presented to our hospital with acute non puerperal complete uterine inversion with something coming out per vaginum of sudden onset while straining at defecation, lower abdominal pain and minimal bleeding per vaginum with history of uterine fibroid and chronic constipation. Diagnosis was confirmed with ultrasonography and examination under anaesthesia after written informed valid consent. After detailed counselling and obtaining written informed valid consent, the patient underwent exploration with a combined abdominal-vaginal approach. Following vaginal myomectomy, the uterus was repositioned using Haultain procedure after a failed attempt of Huntington procedure. Total abdominal hysterectomy with bilateral salpingectomy with vaginal vault suspension was done sparing bilateral ovaries. Diagnosis requires a high index of suspicion and their management is a challenge to gynaecologists due to its rare occurrence, distorted pelvic anatomy and associated pelvic organ injuries during surgery. Good anatomical and clinical knowledge along with surgical skills is of utmost importance for successful outcomes.

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A Rare Case of Nonpuerperal Uterine Inversion Managed by a Combined Laparoscopic and Vaginal Approach

Cited by 2 publications

References 11 publications

A Rare Case Report of Successful Laparoscopy-Guided Reduction of Non-Puerperal Uterine Inversion

A Rare Case Report of Successful Laparoscopy-Guided Reduction of Non-Puerperal Uterine Inversion

A rare case of acute non puerperal complete uterine inversion in nulliparous virgin female

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