ABSTRACT
Chronic uterine inversion is a very rare and often difficult to distinguish between uterovaginal prolapse, submucous fibroid and cervical fibroid. Its diagnosis is based on high index of suspicion. A 50-year-old Para-3Live-3 tubectomised postmenopausal women with k/c/o psychiatric illness, resident R/0 Jambhrun, Mudhkhed came to our hospital with a complaint of irreducible mass protruding per vaginum since 2-3 months duration Subsequently vaginal hysterectomy has been done. The certainty of diagnosis of inverted uterus reached intraoperatively. Gross examination of cut uterus showed fundally located sub-mucous fibroid and specimen sent for histo-pathological report. Non puerperal chronic inversion of uterus is rare condition occurring in approximately 17% of all uterine inversions and most uterine inversions are acute and puerperal. Its incidence is 1/30,000 deliveries and is considered a serious complication of child birth. Most common factor causing inversion -> prolapse and extrusion of fibroids1 especially submucous myoma of fundus (80-85%). Its diagnosis should be considered at any age in post-menopausal period. Superinfection of the infected part should be suspected and treated with appropriate broad-spectrum antibiotics before the surgery.
ABSTRACT
Objetivo: presentar una técnica quirúrgica para la resección de miomas submucosos de gran tamaño por vía histeroscópica. Materiales y métodos: reportamos el caso de una paciente con dos miomas submucosos de gran tamaño, con componente intramiometrial, que fue sometida a miomectomía histeroscópica en la Clínica SOMA, centro de alta complejidad, ubicado en Medellín, Colombia. Se presenta una técnica de miomectomía por histeroscopia con el uso del resectoscopio para disminución del volumen tumoral acompañado de disección roma para crear un plano de clivaje adecuado para la enucleación y extracción completa del tumor. Conclusión: la técnica que combina el uso de la resectoscopia con la enucleación del mioma permitiría la resección de tumores de gran tamaño con menor tiempo quirúrgico, un menor gasto de glicina y, por ende, menor riesgo de intoxicación hídrica y de perforaciones.
Objective: To present a surgical technique for excising large submucosal fibroids using histeroscopy. Materials and methods: We report the case of a patient with two large submucosal fibroids with intramyometrial component, undergoing hysteroscopic myomectomy at Clínica SOMA, a high-complexity institution in Medellin, Colombia. We present a hysteroscopic myomectomy technique using the resectoscope for tumor volume reduction, and the use of a dissection technique that allows to create an adequate cleavage plane for complete tumor removal. Conclusion: A technique combining the use of resectoscopy with fibroid enucleation would allow to resect large tumors with shorter operating time, lower glycine use and, consequently, a lower risk of fluid toxicity and perforations.