Complete Non-puerperal Uterine Inversion in a Nulliparous Woman Due to Sub Mucous Fibroid – a Case Report

Abstract

Uterine inversion which commonly occurs during the puerperium is the descent of the fundus of the uterus into or through the cervix thereby keeping the uterus in an ‘inside out’ position. Other structures such as the ovaries and fallopian tubes may also be displaced from the pelvis and restricted within the inverted uterus. However, non puerperal uterine inversion is very rare and represents about one-sixth of all inversion. The most common implicating factor in non-puerperal inversion is prolapsed fibroid with occasional reports of endometrial polyp and uterine neoplasia. Diagnosis of non-puerperal uterine in version may pose a major problem and treatment in women of reproductive age who desire future fertility may involve conservative surgeries. Case Report: We report a case of a 35 year old nulliparous woman with complaints of sudden protrusion of a mass from her vagina with associated cramping lower abdominal pain and vaginal bleeding. A diagnosis of non puerperal uterine inversion due to sub mucous uterine fibroid was made. Surgical interventions done included excision of fibroid and rectification of the uterus through Haultain’s procedure. Histology confirmed uterine fibroid and patient had resumed normal menstrual flow. Conclusion: High index of suspicion is essential for proper diagnosis of non-puerperal uterine in version. In the setting of fertility sparing surgeries, malignancy need to be ruled out, and the woman must be counseled on interval to next pregnancy and risks associated with different modes of delivery.