A Rare Case of Chronic Uterine Inversion Secondary to Submucosal Fibroid Managed in the Province Hospital of Nepal

Abstract

Uterine inversion secondary to uterine pathology is a rare scenario that a gynecologist encounters. Unlike puerperal uterine inversion, it is misleading and may not always be possible to reduce to normal position without surgery. We report a case of a 35-year female with per vaginal bleeding for fifteen months with a mass-like sensation in the vaginal canal. She presented in shock and had a globular mass in the vaginal canal with the indistinct cervical os. She was resuscitated with blood transfusions and intravenous fluid. She was posted for emergency surgery where myomectomy was done vaginally, and finally, Haultain’s procedure was carried out. The uterus was preserved.

Nonpuerperal vaginal hemorrhage secondary to complete uterine inversion: A case report

“…in 2019 described a case of uterine inversion secondary to a fibroid in a woman with similar symptoms to our case, including vaginal bleeding and fatigue [8] . A case by Singh and Ghimire in 2020 described a patient with 15 months of chronic vaginal bleeding, who finally presented acutely with hypotension and systemic shock, and was ultimately diagnosed with uterine inversion [9] . This case contrasts our patient as Singh and Ghimire describe a long course of abnormal uterine bleeding, whereas our patient had a subacute course (6-weeks) of abnormal uterine bleeding and subsequently presented acutely with complete uterine inversion [9] .…”

“…A case by Singh and Ghimire in 2020 described a patient with 15 months of chronic vaginal bleeding, who finally presented acutely with hypotension and systemic shock, and was ultimately diagnosed with uterine inversion [9] . This case contrasts our patient as Singh and Ghimire describe a long course of abnormal uterine bleeding, whereas our patient had a subacute course (6-weeks) of abnormal uterine bleeding and subsequently presented acutely with complete uterine inversion [9] . A case by Dadgar and Pourhosseini in 2018 was most similar to our patient, where they describe a 51-year-old multiparous female with abnormal uterine bleeding [10] .…”

“…This case demonstrates the severity of this presentation and importance of immediate definitive management through hysterectomy. The 2020 report by Singh and Ghimire suggests an immediate myomectomy and Haultain's procedure as an alternative to hysterectomy to preserve the uterus and child-bearing capability of the patient [9] . Haultain's procedure involves bisecting the myometrial constriction ring through posterior uterine incisions to prevent inversion [9] .…”

“…The 2020 report by Singh and Ghimire suggests an immediate myomectomy and Haultain's procedure as an alternative to hysterectomy to preserve the uterus and child-bearing capability of the patient [9] . Haultain's procedure involves bisecting the myometrial constriction ring through posterior uterine incisions to prevent inversion [9] . Al Qahtani in 2018 described his case's successful surgical management with a vaginal approach with LigaSure [5] .…”

Postnatal inversion of the uterus – management in specific cases.

“…5-6 cm is made longitudinally at the back of the uterine cervix. After that, the muscular coat is sutured with two or three layers of PDS stitches [23]. The Kustner method includes entering the pouch of Douglas vaginally, and splitting the posterior aspect of the uterus and cervix, and finally reinverting the uterus.…”