An exceptional uterine inversion in a virgo patient affected by submucosal leiomyoma: Case report and review of the literature

Abstract

Inversion of the uterus is quite a rare obstetric (puerperal) or gynecological (non-puerperal) condition. Non-puerperal type may be benign or malign mass induced or idiopathic. To the best of our knowledge, this is the first case with a large review of literature of uterine inversion in a patient without sexual experience. We report the case of a 52-year-old, unmarried virgo woman, affected by schizophrenia, was referred to our emergency room for evidence of a mass outside of the vaginal introitus, combined with vaginal bleeding and abdominal pain. The patient underwent vaginal myoma resection and abdominal hysterectomy with bilateral adnexectomy. The diagnosis of uterine inversion was confirmed during operation. Diagnosis of uterine inversion is often not easy and imaging studies might be helpful. Despite the rarity, uterine non-puerperal inversion is possible: for this reason, it is necessary to perform appropriate, conservative treatment, especially in women affected by benign myomas and with a desire for pregnancy.

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

“…To date, less than 200 cases of non-puerperal uterine inversion have been reported in the literature, thus underscoring the rarity of such entity. It is usually tumour associated, with the commonest cause being reported leiomyomas (57.2%), followed by large polyps and malignant tumours including rhabdomyosarcomas, carcinosarcomas and cervical carcinomas [2].…”

“…Patients with non-puerperal uterine inversion have varying clinical manifestations. Although irregular vaginal bleeding is the main symptom, the latter may be associated with epigastric pain, smelly discharge and urinary changes [2,3]. An accurate diagnosis is important because missed or delayed diagnosis of uterine inversion can lead to complications such as haemodynamic instability.…”

“…Clinical presentation can be ambiguous by mimicking other causes of postpartum bleeding and furthermore this particular aspect takes on greater value when it is not associated to the pregnancy. Non-puerperal uterine inversion is an extremely rare condition, thus posing challenges in diagnosis and management of such cases [2].…”

Bilateral obstructive uropathy and severe renal dysfunction associated with large prolapsed pedunculated submucosal leiomyoma of the uterus misdiagnosed as an intracervical fibroid: Report of a very rare case and a mini‑review of the literature

“…Consequently, it is considered that the diagnostic analysis of patients with prolapsed pedunculated submucosal uterine leiomyoma can be confusing, since the gynecological examination may not be able to exclude uterine prolapse or uterine inversion ( 7 , 10 ). Additionally, the elongation and torsion of the vascular pedicle may lead to hemorrhagic and gangrenous degeneration of the prolapsed submucosal leiomyoma, posing a significant challenge in the differential diagnosis from uterine leiomyosarcoma.…”

Inversión uterina no puerperal en paciente con leiomioma uterino: caso clínico

“…Existen teorías asociadas a la fisiopatología en los casos no puerperales entre los que se encuentra la presencia de una pared uterina delgada, un tumor coexistente y de rápido crecimiento que ejerza tracción de forma persistente y crónica hacia el cérvix, llevando a una dilatación de este y además produciendo contracciones uterinas con la intención de expulsar dicho tumor 1 . Otro factor importante que se puede ver asociado es el incremento de la presión intraabdominal por grandes esfuerzos o sobrepeso 12 ; otros factores citados con menor frecuencia en los estudios son la localización del tumor a nivel del fondo uterino, la presencia de un tumor con un pedículo delgado, tamaño grande del tumor, la multiparidad y la edad avanzada 13,14 . En el caso de objeto de estudio, se evidenció la presencia por reporte de patología de un leiomioma uterino, ratificando la causa más frecuente de las inversiones uterinas no puerperales, sin contar con otro factor de riesgo asociado.…”