Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know?

R P Herath,P S Wijesinghe,M Patabendige,M Rashid

doi:10.1155/2020/8625186

R P Herath, P S Wijesinghe + Show 2 more

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https://doi.org/10.1155/2020/8625186

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Abstract

Introduction Nonpuerperal uterine inversion (NPUI) is a rare clinical problem with diagnostic and surgical challenges. The objective of our study was to review the literature on NPUI and describe causative pathologies, diagnosis, and different surgical options available for treatment. Materials and Methods A comprehensive literature review was carried out on MEDLINE and Google Scholar databases to look for NPUI using the term “non-puerperal uterine inversion,” and further went through the cross-references of the published articles. Data are published case reports from 1911 to September 2018. Of the 153 published cases, 133 reports had adequate details of surgery for analysis. These reports were analyzed, concerning the clinical presentation, methods of diagnosis, and surgical treatment. Results Mean age of the women was 46.3 years (standard deviation: 18, N = 153). Leiomyoma remained the commonest (56.2%) aetiology. While malignancies contributed to 32.02% of cases, 9.2% were idiopathic. High degree of clinical suspicion and identification of unique features on ultrasonography and magnetic resonance imaging enable prompt diagnosis. In cases of uncertainty, laparoscopy or biopsy of the mass was used to confirm the diagnosis. Hysterectomy or repositioning and repair of the uterus are the only treatment options available. The surgical methods implemented were analyzed in three aspects: route of surgical access, method of repositioning, and final surgical procedure undertaken. The majority (48.8%) had only abdominal access, while 27.1% had both abdominal and vaginal access. Haultain procedure was the most useful procedure for reposition (18.0%) of the uterus. The majority (39.7%) required abdominal hysterectomy with or without debulking of the tumour abdominally, while 15.0% had uterine repair after repositioning. We reviewed the different surgical techniques and described and proposed a treatment algorithm. Conclusions Fibroids were the commonest cause for NPUI. Malignancies accounted for one-third of cases. A combined abdominal and vaginal approach, followed by hysterectomy or repair after repositioning, seems to be better for nonmalignant cases.

Highlights

Nonpuerperal uterine inversion (NPUI) is a rare clinical problem with diagnostic and surgical challenges. e objective of our study was to review the literature on NPUI and describe causative pathologies, diagnosis, and different surgical options available for treatment
We analyzed the possible causes and the treatment options used by the attending gynecologists in NPUI
Lascarides in 1968 described three important clinical signs in the diagnosis of NPUI: first, the cervical ring may not be recognizable along the proximal part of the mass; second, one cannot find the opening of uterine cervix or probe the endometrial cavity; third, rectal examination reveals that the uterus is not in its normal position in the pelvis, and the cupping of the fundus can sometimes be palpable [72]

Summary

Introduction

Uterine inversion is a condition where the fundus of the uterus turns inside out and the latter prolapses through the cervix. Puerperal uterine inversion was the first uterine inversion type to be recognized, possibly due to its common occurrence. Inversion of the uterus was classified by Jones in 1951 into two types: puerperal or obstetric and nonpuerperal or gynaecological [3]. While puerperal inversions are seen following delivery or miscarriages and may be acute or chronic, the nonpuerperal variety is mostly related to benign or malignant tumours associated with the uterine corpus. Nonpuerperal uterine inversion (NPUI) is rare, and actual incidence is not known. We analyzed the possible causes and the treatment options used by the attending gynecologists in NPUI. The area of the uterine wall weakened by the growth is believed to prolapse into the cavity and be brought under the influence of the active uterine musculature

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