A 52-year-old postmenopausal woman presented with lower abdominal pain, bleeding per-vaginum and a mass protruding per-vaginum of 1-week duration. A clinical diagnosis of non-puerperal uterine inversion due to fundal leiomyoma was made. Non-puerperal uterine inversion is a rare clinical condition and usually follows a benign or malignant mass attached to the fundus of uterus. Surgical procedures described in the literature use different techniques to first reposition the uterus followed by hysterectomy. However, repositioning the uterus is not always successful. Surgery for inverted uterus is technically difficult due to close proximity of the ureters to the ovarian and uterine vessels due to traction on the vascular pedicles, difficulty in repositioning the uterus and constraints of mobilising the bladder down due to the inverted uterus. This paper illustrates the salient steps of surgery to safely accomplish abdominal hysterectomy without repositioning the uterus to treat this rare condition.

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To assess safety and feasibility of non-descent vaginal hysterectomy for benign gynecological disease. METHODS: A prospective study was conducted at the department of obstetrics and gynecology of Vydehi Medical College and research centre from January 2012 to December 2013. An effort was made to perform hysterectomies vaginally in women with benign or premalignant conditions in the absence of prolapse. A suspected adnexal pathology, Endometriosis, immobility of uterus, uterus size more than 16 weeks was excluded from the study. Vaginal hysterectomy was done in usual manner. In bigger size Uterus morcellation techniques like bisection, debulking, decoring, myomectomy, or combination of these were used to remove the uterus. Data regarding age, parity, uterine size, estimated blood loss, length of operation, intra-operative and post-operative complications and hospital stay were recorded. RESULTS: A total of 100 cases were selected for non-descent vaginal hysterectomy. Among them 97 cases successfully underwent non-descent vaginal hysterectomy. Majority of the patients (55%) were in age group of 40-45 yrs. Four patients were nulligravida and eight patients had previous LSCS. Uterus size was ≤12 weeks in 84cases and >12-16 weeks in 16 cases. Commonest indication was leiomyoma of uterus (43%). Mean duration of surgery was 70±20.5 min. Mean blood loss was 150±65 ml. Reasons for failure to perform NDVH was difficulty in opening pouch of Douglas in two cases because of adhesions and in one cases there was difficulty in reaching the fundal myoma which prevented the uterine descent. Intra-operatively one case had bladder injury (1%) that had previous 2 LSCS. Post operatively complications were minimal which included post-operative fever (11%), UTI (8%) and vaginal cuff infection was (4%). Mean hospital stay was 3.5 days. CONCLUSION: Vaginal hysterectomy is safe, feasible in most of the women requiring hysterectomy for benign conditions with less complications and shorter hospital stay. KEYWORDS: Route of hysterectomy, Non descent vaginal hysterectomy, intra-operative and post-operative complications.BACKGROUND: Hysterectomy is one of the most commonly performed major operations. Hysterectomies are performed vaginally, abdominally, or with laparoscopic or robotic assistance. When choosing the route and method of hysterectomy, the physician should take into consideration how the procedure may be performed most safely and cost-effectively to fulfil the medical needs of the patient. 1 Abdominal hysterectomy is undoubtedly the most popular with a 70:30 ratio for abdominal versus vaginal route. 1,2 Gynecologic surgeons worldwide continue to use the abdominal approach for a large majority of hysterectomies that could be performed