Nonpuerperal Uterine Inversion Associated with Endometrial Polyp

Abstract

Abstract

Introduction: Current literature fails to describe an accurate incidence of nonpuerperal uterine inversion as a consequence of its rarity. However, uterine inversion may cause ischemia with subsequent necrosis and infection requiring immediate resolution with little or no prior experience. Case: A 68-year-old multiparous white woman, without prior gynecological surveillance, went to the emergency room complaining of vaginal bleeding. She had had vaginal spotting for the past 3 years. Examination revealed an approximately 10-cm mass filling the vagina. She was admitted for further study and surgery programming. A few hours later she developed abdominal pain, fever, and the mass protruded from the vulva. It was decided that she should immediately undergo surgery. The mass was removed by twisting through the vaginal route. At laparotomy, a doughnut appearance of an inverted uterus with tubes and ovaries abnormally positioned within the crater was observed. Exerting pressure from below and bilateral traction on the round ligaments failed to restore the uterus to normal position. An incision through the full thickness of the posterior uterine wall at the constriction site ring level was performed with combined traction from below, which was successful. Total hysterectomy with bilateral adnexectomy followed without difficulties. Pathological diagnosis was endometrial polyp. Conclusions: Nonpuerperal uterine inversion is a rare condition and the diagnosis is often made during surgery. Ultrasonography and magnetic resonance imaging have been shown useful as diagnostic tools. The authors review the surgical techniques described in the literature. (J GYNECOL SURG 26:215)