Nonpuerperal uterine inversion is a rare entity. Diagnosis is difficult because of the rarity of the condition and is often made at the time of surgery (1). A case of acute complete nonpuerperal uterine inversion with successful operative management is presented. A 41-year-old woman was referred to our hospital for lower abdominal pain and profuse vaginal bleeding of 8 h duration, palpation of a vaginal mass and anemia [hemoglobin (Hb) = 6.1 mg/dL]. She had already been transfused with four units of blood. Her medical history consisted of two previous cesarean sections, 14 and 12 years ago, and a uterine leiomyoma of size approximately 5 cm diagnosed 9 months ago after an episode of menorrhagia, but she had had no symptoms or complaints since then. Initial examination confirmed these findings and we found an Hb concentration of 8.4 mg/dL. The patient was immediately transferred to the operating theatre, suspecting that the cause was an expelled leiomyoma. Attempts at vaginal excision of the mass protruding into the vagina were unsuccessful and bleeding was heavy. Furthermore, neither the cervix nor the uterus could not be palpated. An immediate laparotomy was performed, revealing a complete inversion of the uterus. The bladder fundus, the adnexal structures, such as the fallopian tubes and round ligaments, accompanied the inversion and the ovaries were barely visible in the opening produced by it. Numerous attempts at bimanual reversion of the uterus were unsuccessful and a Haultain procedure was performed, making a midline incision of the posterior uterine inversion ring between the uterosacral ligaments, and performing gradual reversion of the uterus with the fundal leiomyoma. A total hysterectomy was performed to stop the bleeding. The patient received another three units of whole blood and had an Hb concentration of 7.8 mg/dL by the end of the operation. The postoperative period was uneventful and she was discharged on the fifth postoperative day in good condition. Nonpuerperal uterine inversion is a rare entity and its incidence has not been estimated in the literature (2, 3). It is classified as acute or chronic and subclassified as incomplete (fundus protrudes into the uterine cavity but not through the external cervical os), complete (fundus protruding through the external cervical os) or total (inversion of the uterus and part of or the entire vagina) (4). A previous cesarean section has been implicated as a risk factor for puerperal uterine inversion (5). Nonpuerperal inversions occur due to a tumor or an idiopathic event. Most tumors are reported to be uterine leiomyomas and the mechanism involved is thought to be the distension of the cavity, weakening of the uterine walls and the expulsive contractions of the uterus and weight of the tumor itself (4). In idiopathic cases the condition is usually abrupt, accompanied by pain and shock, while in tumor-produced cases it is mostly associated with chronic vaginal discharge and irregular vaginal bleeding (4). This, however, was not the case in our patient in whom a tumor-produced inversion caused the acute onset of lower abdominal pain and profuse vaginal bleeding leading to significant blood loss. Diagnosis can be difficult and two criteria must be applied on clinical examination: 1) nonvisualization of the cervix after excision of the vaginal mass; and 2) nonpalpation of the uterine corpus in bimanual examination with an empty bladder (3). Sonographic characteristics for incomplete inversion are the poor delineation of the endometrial stripe with a Y-shaped configuration (3). Computed tomography diagnosis may be difficult, but nonvisualization of the uterus in the pelvis and visualization of edematous endometrium and myometrium in the middle pelvis are suggestive of the condition (3). Magnetic resonance imaging (MRI) has been used recently for the diagnosis of uterine inversion where the U-shaped cavity may be seen (1). Four surgical procedures (two vaginal and two abdominal) have been used for the treatment of this condition (1, 4). The abdominal Haultain procedure, which consists of incising the constriction ring posteriorly followed by reversion of the uterus, was used successfully in our case. This procedure seems to be safe and effective in reducing the risks of bladder and ureter injury, and is also the procedure of choice in the case of malignant tumors causing the uterine inversion (1).