Total laparoscopic hysterectomy for non-puerperal uterine inversion: anatomical and operative considerations

Abstract

The diagnosis and management of non-puerperal uterine inversion can be challenging. The majority of cases are caused by benign leiomyomas, but 15 % are related to a malignant mass. Published case reports can guide gynaecologists who encounter this rare condition and provide valuable insight in its management. We present a case of non-puerperal uterine inversion in a pre-menopausal woman treated by total laparoscopic hysterectomy. We discuss the challenges we encountered due to the distorted pelvic anatomy and conclusions drawn from a literature review. The article is accompanied by relevant video material. A high level of suspicion is required for the diagnosis of non-puerperal uterine inversion. Morcellation techniques should be avoided due to the potential for malignancy. Where myomectomy is performed vaginally, the possibility of uterine rupture should be taken into account. Management by total laparoscopic hysterectomy has not been reported previously, but appears to be feasible. The technique should be meticulous and aim to identify by dissection important structures.