Chronic Uterine Inversion in a Young Adult: Case Report

Background: Uterine inversion is a rare but serious complication wherein the uterus is partially or completely turned inside out. It can either be acute or chronic. Unlike acute uterine inversion which occurs as a complication during parturition, which can be promptly managed, chronic uterine inversion poses a diagnostic difficulty even for an experienced gynecologist. We, herein, report a patient who was managed and followed up at our institution for chronic uterine inversion. Case presentation: A 30-year-old female, P4L4 previous all vaginally delivered, presented with complaints of something coming out of her vagina, per vaginal bleeding and foul-smelling discharge. On Physical examination, the patient was severely anaemic and revealed a bleeding, necrotic mass on inspection and the entrance of the cervix felt high up on per speculum and per vaginal examination. The patient was diagnosed as having chronic uterine inversion. The patient was admitted and was made hemodynamically stable with intravenous fluids and three units of blood. Manual reduction using vaginal procedure to reposition the uterus wasn’t successful, hence she was taken up for surgery. Fibroid was resected vaginally. Then Haultain rectification procedure was performed and then the definitive procedure of hysterectomy was done. Postoperatively, the patient was kept under observation and was vitally stable. Histopathology reported leiomyoma. Conclusion: Though non-puerperal uterine inversion is rare, a few cases will still have to be managed without any previous experience. This differential has to be considered as a possibility in a non-pregnant woman presenting with bleeding or mass per vagina with or without hypotension and can very rarely present as postmenopausal bleeding. Irrespective of age or parity, pre-operatively or intra-operatively, associated malignancy is to be ruled out in every case of uterine inversion. The prognosis depends on prompt diagnosis and timely intervention. Keywords: Fibroid, chronic, non-puerperal, uterus, inversion.