Non-puerperal Uterine Inversion Research Articles

Non-Puerperal Uterine Inversion Caused by Embryonal Rhabdomyosarcoma in an Adolescent: A Case Report

Introduction: Non-puerperal uterine inversion is an uncommon gynecologic emergency that can be triggered by either malignant or, more commonly, benign tumors. Uterine sarcoma, including the rare subtype known as embryonal rhabdomyosarcoma, is among the malignant causes. The management of this condition poses a significant challenge for surgeons. Case Report: A 15-year-old nulliparous and virgin female arrived at the emergency department in hemorrhagic hypovolemic shock, experiencing pelvic discomfort and expelling endometrial tissue through the vagina. She underwent a total abdominal hysterectomy with bilateral oophorectomy, a pathological examination revealed that the uterine inversion was caused by embryonal rhabdomyosarcoma. Subsequently, the patient was referred to an oncologist for chemotherapy. Conclusion: Rapid perioperative diagnosis can be achieved through physical examination and magnetic resonance imaging (MRI), with histopathological examination serving as the definitive diagnostic confirmation tool.

Acute non peurperal uterine inversion caused by leiomyma associated with precancerous lesions: A case report

Introduction and importance: Acute non-puerperal uterine inversion (Acute NPUI) is a rare clinical entity that is usually associated with a polypoid uterine tumor, usually a leiomyoma, but its occurrence due to combined leiomyoma with precancerous lesions is quite exceptional. Case presentation: Here, the authors present the case of a 65-year-old woman who was diagnosed with acute NPUI as an unusual complication of prolapsed fibroid. Clinical discussion: On abdominal examination, palpation of the lower abdomen was very painful. On pelvic examination, a huge hemorrhagic mass was noticed, with necrotic areas protruding at a level 10 cm above the introitus. The cervix could not be palpated or visualized, and the uterus was difficult to appreciate on a bimanual examination due to tenderness. By transabdominal sonography, the uterus could not be clearly identified. Routine blood tests were completely normal, including hemoglobin concentrations. First of all, we manually replaced the inverted uterus in its normal position and then performed a total hysterectomy and a bilateral adnexectomy. Pathological findings demonstrated a leiomyoma with areas of complex hyperplasia with atypia! Conclusion: When we encounter a case of non-puerperal uterine inversion, we must consider fibroids as the most common cause, and we must act quickly so that the patient does not go into neurogenic shock and die. Although leiomyoma is the most common cause of NPUI, a pathological study should be performed in all cases.

A Rare Case of Non-Puerperal Uterine Inversion Associated with Adenosarcoma of the Uterus: A Case Report

A Rare Case of Non-Puerperal Uterine Inversion Associated with Adenosarcoma of the Uterus: A Case Report

Non-Puerperal Uterine Inversion Associated with Embryonal Rhabdomyosarcoma: A Case Report.

Non-Puerperal Uterine Inversion Associated with Embryonal Rhabdomyosarcoma: A Case Report.

Non-Gravid Uterine Inversion in a Postmenopausal Woman Using a Combined Vaginal and Laparoscopic Approach: A Case Report

Non-puerperal uterine inversion is an extremely rare medical and surgical emergency. It is more commonly described in obstetrics, exposing the mother to the risk of cataclysmic delivery haemorrhage. We report the case of a 48 year old patient presenting with acute 4th degree uterine inversion on a submucosal fundial myoma. Total interannexal hysterectomy was performed via a double approach: vaginal and laparoscopic. The laparoscopic approach enabled the diagnosis to be confirmed and the hysterectomy to be performed in complete safety.

Nonpuerperal uterine inversion with a submucosal leiomyoma: A case report

Background: Nonpuerperal uterine inversion is a rare gynecological condition that is not preceded by pregnancy. It may be induced by uterine tumors or may be idiopathic.
 Case presentation: A 28-year-old presented with a vaginal mass associated with urine retention, vaginal bleeding, and an off-white discharge. Pelvic sonography performed earlier revealed uterine procidentia features. On examination under anesthesia, the vaginal mass turned out to be an inverted uterus with a submucosal fibroid. The fibroid was avulsed. Bladder dissection and hysterotomy were performed, and the uterus was reduced into the abdominal cavity. She recovered well postoperatively with complete symptom resolution.
 Conclusion: Nonpuerperal uterine inversion is a rare and potentially life-threatening condition, which presents with nonspecific symptoms and presents diagnostic and management challenges. Management is usually surgical as conservative measures have been shown to be less effective. Timely diagnosis and management is key in reducing associated morbidity and mortality.

A Case Report of Non-puerperal Uterine Inversion

Objective: Non-puerperal uterine inversion is a rare occurrence. The common etiology for this condition is uterine sarcoma, endometrial carcinoma, and myoma. Case report: This case is a 44-year old woman with a protruding malodorous vaginal mass, abdominal pain, and urinary retention. Total hysterectomy with bilateral salpingectomy was performed. Conclusion: Diagnosis of uterine inversion might be difficult and requires a high index of suspicion.

Successful Outcome of a Rare Complication of Vaginal Birth: A Case Report

Uterine inversion is a condition in which the interior surface of the relaxed uterus protrudes through the vaginal entrance. Its causes are divided into two categories: puerperal and non-puerperal, with puerperal uterine inversion being more common than non-puerperal uterine inversion. The most common variety is acute inversion, which occurs immediately or within 24 hours after delivery. Chronic Uterine Inversions (CUI) that occur more than four weeks after delivery are uncommon. In this study we discuss a case of a 30-year-old woman who came with the complaints of feeling of a mass in the vagina after her last confinement which was gradually coming down through the vagina and remain outside the introitus for 5 years. Based on clinical and sonographic evaluation, she was diagnosed with CUI and developed post partum haemorrhage. We adopted Haultain’s method for correction of CUI. Since, CUI as a painless vaginal mass in the delayed post-partum period is uncommon and hence documented.

Uterine Inversion.

HomeRadioGraphicsVol. 43, No. 6 PreviousNext Cases from the Cooky JarFree AccessUterine InversionKaitlin M. Zaki-Metias , Melina Hosseiny, Fardad Behzadi, Patricia BalthazarKaitlin M. Zaki-Metias , Melina Hosseiny, Fardad Behzadi, Patricia BalthazarAuthor AffiliationsFrom the Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, 44405 Woodward Ave, Medical Education, Pontiac, MI 48341 (K.M.Z.M.); Department of Radiology, University of California San Diego, San Diego, Calif (M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (F.B.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.).Address correspondence to K.M.Z.M. (email: [email protected]).Kaitlin M. Zaki-Metias Melina HosseinyFardad BehzadiPatricia BalthazarPublished Online:May 18 2023https://doi.org/10.1148/rg.230004MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Uterine inversion, or uterine intussusception, is a rare, potentially life-threatening entity characterized by inversion of the fundus into the uterine cavity, which often manifests as an acute complication of childbirth (1,2). Less commonly, uterine inversion is nonpuerperal, occurring as a result of an endometrial or myometrial mass (2,3). Patients typically present with symptoms that include vaginal bleeding and pelvic pain.At MRI, uterine inversion appears as a U-shaped uterus with loss of the normal convex fundal contour on sagittal images (Fig 1A, 1B) (2). A target configuration may be visualized on axial images, representing the concentric serosa, myometrium, and endometrium (Fig 1C, 1D) (2). MRI is also useful in assessing the cause in patients with nonpuerperal uterine inversion, including submucosal leiomyomas, uterine leiomyosarcomas, and endometrial malignancies. There are four grades of uterine inversion, which are characterized by the degree of inferior bowing of the fundus relative to the cervix and/or vaginal introitus (Fig 2).Figure 1. Uterine inversion in a previously healthy premenopausal female patient with acute onset of pelvic pain and vaginal bleeding. A bleeding vaginal or cervical mass was suspected on physical examination, and pelvic MRI was performed for further evaluation. Sagittal T2-weighted (A) and contrast-enhanced fat-suppressed T1-weighted (B) MR images of the pelvis demonstrate a U-shaped uterus (U) with loss of the normal fundal contour, with protrusion of the fundus into the distended vaginal canal (V), consistent with grade III uterine inversion. The cervix (C) is located superior to the inverted fundus. At the fundus, there is an ill-defined rounded lesion (arrow in A and B) with heterogeneous T1 signal intensity and enhancement with irregular margins, with adjacent heterogeneous T2 signal intensity and increased T1 signal intensity. The findings are most consistent with a hemorrhagic submucosal uterine leiomyoma. Axial T2-weighted (C) and contrast-enhanced fat-suppressed T1-weighted (D) MR images of the pelvis show concentric rings of signal intensity indicating the serosa, myometrium, endometrium, and vagina.Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. Illustration depicts the normal anatomic position of the uterus (A) and the various grades of inversion. Grade I uterine inversion (B) is characterized by inferior bowing of the fundus up to but not beyond the cervix. In grade II uterine inversion (C), the inverted fundus protrudes through the cervix and into the vagina. The uterus is fully inverted and protrudes out of the vagina in grade III uterine inversion (D).Figure 2.Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest.—K.M.Z.M. Meeting attendance and travel reimbursement from Trinity Health Oakland Hospital. P.B. Editorial board member of RadioGraphics, Association of University Radiologists GE Radiology Research Academic Fellowship, meeting travel reimbursement from the American College of Radiology.K.M.Z.M and P.B. have provided disclosures (see end of article); all other authors have disclosed no relevant relationships.

Non-Puerperal Uterine Inversion Secondary to Prolapsed Tumours about Two Cases

Background: Non-puerperal uterine inversion (NPUI) is a rare gynecological affection whose scarcity makes its diagnosis challenging. Uterine inversion may be -acute- most seen in obstetrics as a complication of the third stage of labor or- chronic- due to uterine benign or malign tumors. Case report: We proffer two cases of non-puerperal uterine inversion presenting to our emergency department complaining of a protruded mass through the vagina outside the introitus. The first one outlays the second reported case - to our knowledge- in a patient without sexual experience of a uterine inversion due to a leiomyosarcoma, presenting in an acute state, leading to hemorrhagic shock. The second case occurs after recurring uterine inversions due to a known submucosal myoma. Both diagnoses relied on physical examination where not being able to palpate the uterus was the cornerstone of clinical suspicion. Using ultrasound as imaging investigation was pivotal to confirming the diagnosis and an etiology, uterine tumors. For different reasons, both patients underwent transvaginal hysterectomy. Conclusion: NPUI is a complicated clinical condition where the diagnosis is often exacting. If accurately and timely managed, it has an excellent prognosis. It’s very important to define the tumor’s histopathological profile before choosing one of the underlining known surgical and non-surgical procedures. However, taking into consideration fertility and the patient’s desire should be mandatory before deciding on any course of action.

Inversion of uterus due to prolapsed submucous fundal fibroid

Inversion of uterus is rarely encountered by gynecologist during practice; inversion in a non- pregnant uterus is further rarer; only case reports are published in literature on non-puerperal uterine inversion. We present a case of a 40-years multipara who had a history of irregular and excessive vaginal bleeding associated with severe lower abdominal pain during vaginal bleeding for two years. She was referred from general hospital with suspicion of cervical cancer. Being a rare clinical condition diagnosis and management of uterine inversion is challenging. High index of clinical suspicion is necessary which can be aided by radiographic imaging. Our case was diagnosed as a case of complete uterine inversion secondary to fundal fibroid clinically. She underwent abdominal hysterectomy with bilateral salpingectomy with bilateral sacrospinous vault suspension after resuscitation with fluids, blood transfusion and broad-spectrum antibiotics.

Subacute Non-Puerperal Uterine Inversion: A Rare Complication of Uterine Myoma

Subacute non-puerperal uterine inversion is an extremely rare clinical situation that constitutes a medico-surgical emergency that can be life-threatening for women due to the risk of bleeding. We report the case of a 45 years-old patient, second parous received urgently with hemorrhagic shock. The clinical examination confirmed the diagnosis of uterine inversion secondary to a fundic myoma type 0 delivered through the cervix. Resuscitation was carried out followed by surgical management by a mixed vaginal and abdominal approach to perform a hysterectomy. Through this clinical case, we recall the epidemiological aspects of this pathology as well as the diagnostic and therapeutic difficulties.

US and MRI contribution in non-puerperal uterine inversion: A case report

Uterine inversion is a rare and potentially life-threatening complication. It is mainly of two types: puerperal and non-puerperal with further subdivision into complete and incomplete. Earlier diagnosis was crucial in order to avoid irreversible damage to the reproductive organs and adjacent structures. We present a case of a 45-year-old woman where the imaging diagnosis of her chronic pelvic pain fortuitously revealed a non-puerperal uterine inversion. This rare case emphasized the importance of a better understanding of the pelvic anatomy by radiologist in order to facilitate the comprehension of such pathologies with lost clear anatomy in imaging.

Uterine inversions of tumor origin in two cases at the Joliot Curie Institute at the Aristide Le Dantec University Hospital Center

INTRODUCTION: Non-puerperal uterine inversions are a rare situation. Indeed, 85% of uterine inversions are puerperal. We
 report two cases observed at the Joliot Curie Institute of the Aristide le Dantec University Hospital. OBSERVATIONS: It was about a 39-year-old primigravida and a 47-year-old seventh gestational patient, who had a stage 4 of uterine inversion picture in relation to uterine sarcoma and uterine myoma respectively. The diagnosis was suspected at the clinic due to the absence of palpation of the uterus. Confirmation was made on medical imaging and intraoperatively. Management was radical with a total hysterectomy with bilateral adnexectomy via the vaginal and abdominal routes. However, in the first patient with sarcoma, surgery combined bilateral pelvic lymphadenectomy and was preceded by chemotherapy. CONCLUSION: Non-puerperal uterine inversion is a rare situation. Its treatment is essentially surgical. However, it is important to look for an etiology and in the case of a tumor to ensure that the mass is a cancer or not because the management and prognosis depend on it.

Modified vaginal hysterectomy for chronic non-puerperal complete uterine inversion: video presentation.

Chronic non-puerperal complete uterine inversion is a relatively rare condition. Abdominal Haultain's operation is the usual management. We present such a case with fundal fibroids managed by modified vaginal hysterectomy. Preoperative computerized tomography enhanced intravenous urogram depicted normal ureters and bladder. Diluted vasopressin (10 U in 100 ml normal saline) was infiltrated at the base of the myoma and a myomectomy was performed. The fundal raw area was pierced to reach the formed space between the anterior and posterior uterine serosa. The bilateral round ligaments were clamped, cut, and ligated. Diluted vasopressin was injected into the fundal anterior uterine wall and about 1 cm was excised. Then, the bilateral utero-ovarian ligaments were clamped, cut, and ligated. In the same way another 1 cm of anterior uterine wall was excised and the bilateral uterine vessels were clamped, cut, and ligated. The rest of the uterine wall area was infiltrated with diluted vasopressin circumferentially. An incision at the vesico-cervical junction was made and the bladder pushed up. The posterior fornix area was incised and the Pouch of Douglas (POD) opened. Vesico-uterine pouch opened under finger guidance placed through POD. The rest of the anterior uterine wall was excised. Exposed bilateral cardinal-uterosacral ligament complexes (CULCs) were clamped, cut, and ligated. The remaining vaginal attachments ligated hemostatically and the vault was closed. For vault prolapse prevention, vault closure suture ends were tied with ipsilateral CULC suture end, brought outside the vagina at vault angle. A follow-up visit up to 1 year found no complications. This novel reverse vaginal hysterectomy combining the principles of both abdominal and vaginal hysterectomy can successfully manage chronic non-puerperal complete uterine inversion.

Uterine Inversion Secondary to a Large Prolapsed Leiomyoma: Diagnostic and Management Challenges

[This retracts the article DOI: 10.7759/cureus.7168.].

Inversión uterina no puerperal: primer caso reportado en el Perú

La inversión uterina no puerperal es muy rara. Se comunica un caso asociado con leiomiomatosis. Se trató de una multípara de 45 años que manifestó sangrado vaginal grave, dolor pélvico y sensación de cuerpo extraño vaginal. Se diagnosticó mioma uterino en fase abortiva. Se programó para miomectomía con probable histerectomía abdominal y se encontró inversión uterina completa. Este reporte constituye un caso anecdótico de inversión uterina no puerperal, cuyo tratamiento quirúrgico fue exitoso.

Non-puerperal uterine inversion: An uncommon presentation - A case report

Spontaneous nonpuerperal uterine inversion is an exceedingly rare gynecological event. When it occurs, it is often due to an intrauterine polypoid mass attached to the uterine fundus, eventually pulling the uterus inside out over time as the mass increases in size. We present a case of nonpuerperal uterine inversion in a 32-year-old female who presented with heavy vaginal bleeding and vaginal protrusion of a fleshy mass. A clinical diagnosis of chronic uterine inversion due to a pedunculated submucous fibroid was made and was surgically managed with a vaginal myomectomy combined with an exploratory laparotomy and surgical reduction under general anesthesia. Good clinical acumen and surgical skills are invaluable for accurate diagnosis and appropriate treatment of nonpuerperal uterine inversion.

Non Puerperal Uterine Inversion Secondary to Submucosal Fibroid: A Case Report

Non Puerperal Uterine Inversion (NPUI) is a very uncommon condition. The incidence of puerparal uterine inversion make an estimate of 1/30,000 deliveries and NPUI approximately 17% of all uterine inversion. The most common cause which leads to uterine inversion is a submucous myoma attached to the fundus but diagnosis can be difficult to make. The management of uterine inversion is always challenging for a surgeon. In the present case a 38-year-old woman, presented with significant anaemia because of menorrhagia. She used to feel mass occasionally into the vaginal canal which never comes out of the introitus, the mass was elucidated as a fibroid polyp. On investigation, her haemoglobin was 6.6 gm%, with continous bleeding per vaginum, patient was transfused with three units packed red blood cells and planned for surgery. A diagnosis of incomplete uterine inversion secondary to a submucous fibroid was made at exploratory laparotomy. Total abdominal hysterectomy, right salpingectomy with left salpingo-oophorectomy was performed. The patient was discharged under satisfactory condition.

Non-Puerperal Uterine Inversion in a Nulliparous Woman with no Uterine Mass: A Case Report and a Literature Review

Background: Non-puerperal uterine inversion (NPUI) is an extremely rare condition. Most reported cases of uterine inversion ware in multiparous women. Moreover, non-puerperal uterine inversion usually occurs when there is a benign or malignant uterine mass present. In literature, there have been only 9 reported cases of non-puerperal uterine inversion in a nulliparous woman in the 10 year window from 2006 to 2017 [1]. Case: Here, a case of non-puerperal uterine inversion is discussed. Initially the patient was diagnosed as a sub-mucosal fibroid of the uterus. The diagnosis of Non-puerperal uterine inversion was made only during operation. But the case reported in this paper, is the first reported case in a patient who did not have any uterine mass and also was nulliparous. At first, an attempt to reposition the uterus was made by Huntington method but was failed. Then, it was decided to perform the total abdominal hysterectomy. Her postoperative period was uneventful and she was discharged without complication after only seven days. Conclusion: Non-puerperal uterine inversion is rarely encountered by Gynecologist. However, the rare occurrence of this case is often difficult to diagnose, especially when the exact cause of the condition is not known preoperatively. Our patient was lean, thin and malnourished, suffered from general weakness for long time. Could the weakness of the uterine muscle and ligaments be the cause for inversion? The reported case provides an indication for future research on the causes of nonpuerperal uterine inversion, specifically the scenario which has no association to uterine mass in a nulliparous woman.