Interesting case of uterine inversion-managed laparoscopically

Abstract

Abstract 32-year-old unmarried woman presented with complaints of severe abdominal pain for 2 hours. The pain was sudden in origin, continuous in nature associated with giddiness and vomiting. She had got her menses a day prior , bleeding was heavy with passage of clots. She had menorrhagia for 5 months. On examination, pulse was 112 beats per minute, blood pressure was 100/60mmHg, severe pallor was present. On per vagina examination large fleshy mass was seen protruding in the vagina, cervix was not seen. On per vaginal examination, a globular mass was felt, while cervix could not be palpated separately. Uterine fundus was not palpable. A provisional diagnosis of Uterine inversion was made with a probable prolapsed fibroid or polyp. MRI pelvis confirmed the diagnosis. Her haemoglobin was 5 gm%, and coagulation profile was normal. On laparoscopy, uterine fundus was not visible, the fallopian tubes and ovaries seemed to be pulled into the vagina. Vasopressin was injected and incision was taken on posterior uterine wall (Haultain’s method ) to correct inversion. The uterine walls were slowly pulled upwards using tissue grasping forceps. The myoma was seen after incising the uterine walls. Myoma screw was used to completely enucleate the myoma from uterine bed. The bleeders in myoma bed were coagulated. Posterior uterine wall was sutured using barbed sutures. Bilateral round ligaments were plicated to provide additional strength. An adhesion barrier was placed over the sutured uterine wall to prevent adhesions. She received a total of 4 units of whole blood and 4 units of fresh frozen plasma. She was discharged on day 5 post surgery. Her post-operative course was uneventful. We are presenting this case due to its rare presentation in unmarried female and laparoscopic management of this case by Haultain’s method.