NON-PUERPERAL TOTAL UTERINE INVERSION DUE TO A LEIOMYOMA: A CASE REPORT

Chimi Hanae*, Kifani Rim, Loukili Najwa, Wissal Zahir, Rachid Maakoul and Bargach Samir

ABSTRACT

Introduction: Uterine inversion is an extremely rare gynecological complication, that characterized by the folding of the fundus into the uterine cavity reaching the cervix or beyond the cervix. It is most commonly associated with benign tumors such as submucosal leiomyomas. It’s an extremely rare gynecological condition which is an obstetric emergency and a diagnostic challenge in gynecology. There should be high index of suspicion in the setting of a mass protruding from the vagina, non-palpable uterus, and pelvic organs not visualized on ultrasound. Case Presentation: We report the case of a 50-year-old woman, gravida four para four, admitted to the emergency’s department for an irregular vaginal bleeding, pelvic pain and externalized mass through the vulva evolving for 3 days. A total interannexial hysterectomy was performed via dual approach with vaginal route supplemented by laparotomy. Histopathological examination confirmed uterine inversion originating from a fundal myoma with no malignancy. The postoperative course was uneventful and she was discharged without complication. Discussion: Uterine inversion, where the uterus turns inside out by descending through the cervix, predominantly affects older women outside of childbirth, often due to uterine malignancies in younger patients. Diagnosis poses challenges, as it mimics other conditions and varies in severity from incomplete to total inversion. Imaging, such as ultrasound and MRI, aids in diagnosis. Treatment typically involves hysterectomy, although conservative options are considered for certain cases. Surgical techniques vary based on the extent of inversion and patient-specific factors, aiming to restore normal anatomy and function while addressing underlying pathology. Conclusion: Non-puerperal uterine inversion represents a severe complication. It is most commonly associated with benign tumors such as leiomyomas, however the possibility of an underlying malignancy should not be neglected. Total hysterectomy using a dual approach via laparoscopy and vaginal access is a reliable and safe surgical technique.

Keywords: Uterine inversion, Non-puerperal uterine inversion, leiomyoma.