A Rare Case Report of Successful Laparoscopy-Guided Reduction of Non-Puerperal Uterine Inversion

Abstract

Non-puerperal uterine inversion is an extremely rare and potentially dangerous condition. Cases are poorly described in the literature, and their actual incidence is unknown. A 34-year-old nulliparous female patient visited the emergency department following a loss of consciousness. She had experienced continuous vaginal bleeding over the preceding two months, with a two-day history of worsening symptoms. The patient showed signs of hypovolemic shock secondary to unceasing vaginal bleeding. Ultrasound and computed tomography revealed an inverted uterus and a large hematoma inside the patient’s vaginal cavity. An emergency explorative laparoscopy was performed, which confirmed uterine inversion. Initially, Johnson’s maneuver was attempted under laparoscopic visualization, but this failed to achieve uterine reduction. Following the unsuccessful performance of Huntington’s maneuver, a re-trial of the manual reduction allowed the uterus to recover to its normal anatomy. The patient’s vaginal bleeding was dramatically reduced after successful uterine reduction. The pathologic report conducted confirmed endometrioid adenocarcinoma. Laparoscopic visualization is a feasible and safe procedure for achieving uterine reduction in cases of non-puerperal uterine inversion with an unconfirmed pathology. Uterine malignancies should be considered in patients with non-puerperal uterine inversion.

Acute puerperal uterine inversion with successful manual transvaginal repositioning: A case report

“…[2] Postpartum uterine wall relaxation, cervical dilatation, placental adherence, short umbilical cord, sudden uterine emptying, midwife compression of the uterine fundus, or excessive pulling of the umbilical cord when the placenta is not stripped, can induce uterine inversion. [6] In the case of nonpuerperal uterine inversion can be due to outward growth of uterine submucosal fibroids, [7] endometrial polyps, [8] and uterine malignant tumors [9][10][11][12] (e.g., endometrial carcinoma, rhabdomyosarcoma), which result in the uterine fundus turning out. Depending on the degree of inversion, it can be categorized into 4 degrees.…”

“…Operative procedures used include Huntington procedure, Haultain procedure, Kustner approach, etc, and some patients may need to undergo hysterectomy. [7,9,26,27] Laparoscopic visualization is feasible and safe in cases of nonpuerperal uterine involution with undetermined pathology. [9] Robot-assisted laparoscopic supracervical repair for chronic puerperal uterine inversion preserves the integrity of the cervix and may reduce adverse effects on future pregnancies.…”

“…[7,9,26,27] Laparoscopic visualization is feasible and safe in cases of nonpuerperal uterine involution with undetermined pathology. [9] Robot-assisted laparoscopic supracervical repair for chronic puerperal uterine inversion preserves the integrity of the cervix and may reduce adverse effects on future pregnancies. [28] If the patient undergoes surgical correction of uterine inversion, it is safer to opt for cesarean section in subsequent pregnancies, taking into account that the uterine fundus or corpus has been incised.…”