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

La inversión uterina es una patología de presentación rara e infrecuente. Se presenta el caso de una paciente con inversión uterina no puerperal con requerimiento de histerectomía abdominal total. Sin antecedentes de importancia asistió al servicio de urgencias por un cuadro clínico de dolor abdominal de 10 días de evolución asociado a sangrado vaginal abundante con inestabilidad hemodinámica y sensación de masa vaginal. Al examen físico se evidenció una masa sobresaliente del canal vaginal de aspecto necrótico, por lo que se sospechó mioma nascens. Durante la estancia hospitalaria presentó inestabilidad hemodinámica, por lo que fue llevada a histerectomía abdominal de urgencia con hallazgo de inversión uterina. La inversión uterina no puerperal es infrecuente. Es importante realizar un buen diagnóstico clínico apoyado de las imágenes si se encuentran disponibles, la intervención quirúrgica es necesaria y proporciona un buen pronóstico. La histerectomía vaginal no es sencilla en estos casos, por lo que se recomienda la histerectomía abdominal total.

Uterine inversion is a rare and infrequent disease. The case of a patient with a non-puerperal uterine inversion that had to be treated with a total abdominal hysterectomy is presented in this study. With no important history of disease, she attended the emergency department presenting abdominal pain in the last 10 days associated with vaginal bleeding and mass sensation. The physical examination revealed a protruding necrotic-like mass through the vagina, hence the suspicion of a myoma nascens. During her hospital ward stay, she presented hemodynamic instability, urgent abdominal hysterectomy had to be done which revealed uterine inversion. Non-puerperal uterine inversion is infrequent. Precise clinical diagnosis is important supported by diagnostic imaging if available. The surgical intervention is necessary, giving a good prognosis. Vaginal hysterectomy is not easy in this type of cases, therefore total abdominal hysterectomy is recommended.

Inversión uterina no puerperal: primer caso reportado en el Perú / Non-puerperal uterine inversion: first case reported in Peru

RESUMEN La inversión uterina no puerperal es muy rara. Se comunica un caso asociado con leiomiomatosis. Se trató de una multípara de 45 años que manifestó sangrado vaginal grave, dolor pélvico y sensación de cuerpo extraño vaginal. Se diagnosticó mioma uterino en fase abortiva. Se programó para miomectomía con probable histerectomía abdominal y se encontró inversión uterina completa. Este reporte constituye un caso anecdótico de inversión uterina no puerperal, cuyo tratamiento quirúrgico fue exitoso.

ABSTRACT Non-puerperal uterine inversion is very rare. A case associated with leiomyomatosis is reported. The case of a 45-year-old multiparous woman with severe vaginal bleeding, pelvic pain and vaginal foreign body sensation is presented. Uterine leiomyoma in abortive phase was diagnosed. She was scheduled for myomectomy with probable abdominal hysterectomy and complete uterine inversion was found. This report is an anecdotal case of non-puerperal uterine inversion, whose surgical treatment was successful.

Chronic non puerperal uterine inversion due to submucosal fibroid: a rare case report

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.

Hemorragia puerperal por inversão uterina: relato de caso / Puerperal hemorrhage after uterine inversion: a case report

A inversão uterina aguda no pós-parto é uma emergência obstétrica rara e potencialmente fatal, que ocorre nas primeiras 24 horas do puerpério e tem importante associação com hemorragia puerperal. Relata-se um caso de uma primípara de 19 anos, que após indução de parto devido a oligoâmnio, apresentou importante sangramento transvaginal, com instabilidade hemodinâmica. Teve seu reconhecimento e tratamento prontamente realizados, e assim não evoluiu com complicações. O reposicionamento é primeiramente tentado pela manobra de Taxe com uso de relaxantes uterinos, e caso falhe, opta-se por cirurgia. O prognóstico depende justamente da agilidade da intervenção terapêutica, que permite completa recuperação do quadro e ausência de sequelas.

Acute postpartum uterine inversion is a rare, potentially fatal obstetric emergency occurring within the first 24 hours of the puerperium, and which is closely associated with puerperal hemorrhage. In this case report, a 19-year-old primiparous woman had significant transvaginal bleeding, with hemodynamic instability, after induction of labor due to oligoamnios. The case was diagnosed and treated promptly, thus the patient evolved without complications. The standard treatment protocol usually comprises Taxe maneuver (manual uterine replacement) followed by uterine relaxants; only if it fails, surgery is performed. The prognosis depends precisely on prompt therapeutic intervention, which leads to complete recovery of the condition, as well as absence of sequelae.

A Rare Case of Postmenopausal Uterine Inversion

@#Uterine inversion is a rare complication of delivery, and rarer still is a non-puerperal uterine inversion. Anecdotally some gynaecologists do not come across such cases in their whole career. The following case will illustrate a case of uterine inversion and its management undertaken at Labasa Hospital.

Chronic uterine inversion associated with uterine leiomyoma misdiagnosed as cervical fibroid: a case report

Chronic inversion of uterus is a rare clinical entity which is usually associated with obstetrics complication and rarely with gynaecological disorder like fibroid present at fundus of uterus. We here present a case of 40-year-old female P3L3 with chronic inversion of uterus with fundal fibroid which present with 3year history of abnormal vaginal bleeding. Ultrasonography and MRI revealed cervical fibroid. Due to AUB secondary to cervical fibroid decision of hysterectomy was taken. On laparotomy chronic uterine inversion was present which was corrected by haultain’s procedure. Then hysterectomy was done. Histopathology report suggestive of uterine leiomyoma at fundus of uterus. Chronic uterine inversion associated most commonly with fundal submucous leiomyoma. Other causes are leiomyosarcoma, endometrial carcinoma, cervical carcinoma, rhabdomyosarcoma, mixed mullerian sarcoma. It is an extremely rare gynaecological condition and can be misdiagnosed as cervical fibroid, advanced cervical malignancy or other causes of AUB in females. It could be labelled as gynaecological near miss so a high index of suspicion is necessary for it’s diagnosis.

Chronic non-puerperal uterine inversion in the absence of risk factors: a rare case report

Non puerperal chronic uterine inversion is a rare entity; representing 1/6th of all uterine inversions. Usually precipitated by risk factors like fibroid uterus, endometrial polyp, endometrial malignancies. We present a case of 25 year old P2L2 with irregular vaginal bleeding and pain abdomen, with severe anemia. On per abdomen examination no abnormality detected, per speculum revealed a red friable mass 5*5cms protruding through vagina and per vaginal examination same findings confirmed. A diagnosis of fibroid polyp made initially and planned for polypectomy after correction of anemia. Under spinal aneasthesia diagnosis was changed to uterine inversion. Exploratory laparotomy done, which revealed characteristic flower pot appearance. Inversion was corrected by Haultens method, where in posteriorly incision was given to cut the tight cervical ring, and uterus was repositioned back to normal anatomic positon. Bilateral tubal sterilization was done as per patients request. Post operative period was uneventful and she was discharged in stable condition. Thus chronic non puerperal uterine inversion can be difficult to diagnose in the absence of risk factors.

Non-puerperal uterine inversion associated with myomatosis

SUMMARY Uterine inversion is an uncommon complication of the puerperium and it is an even rarer complication of the non-puerperal period. In this way, uterine inversions are classified into two groups, being of puerperal origin due to obstetric problems and non-puerperal origin due to gynecological problems. In general, a non-puerperal uterine inversion occurs as a possible complication of a sub mucosal leiomyoma, after an expansive process, a dilation of the cervix occurs and thus its protuberance over the vaginal canal.

RESUMO A inversão uterina é uma complicação incomum do puerpério e é uma complicação ainda mais rara do período não puerperal. Dessa forma, as inversões uterinas são classificadas em dois grupos, sendo as de origem puerperal decorrentes de problemas obstétricos e as inversões de origem não puerperal decorrentes de problemas ginecológicos. Em geral, a inversão uterina não puerperal decorre como uma possível complicação de um leiomioma submucoso — após o processo expansivo, ocorre a dilatação do colo uterino e, dessa forma, a sua protusão sobre o canal vaginal.

Inversión uterina puerperal subaguda grado II / Sub-Acute Puerperal Uterine Inversion Grade II

La inversión uterina obstétrica es una entidad rara, y una de las complicaciones más graves del tercer estadio del parto que pone en peligro la vida de la parturienta. La inversión del útero consiste en un cambio de disposición de sus paredes, la cara interna se convierte en externa y el órgano se invagina en forma de dedo de guante. Es un accidente obstétrico que constituye una verdadera emergencia y es causa de muerte materna por choque hemorrágico. Afortunadamente su incidencia en nuestro país es baja, dado por la escasa cantidad de reportes sobre el tema. El objetivo del trabajo es presentar este caso por la atipicidad en la forma clínica que se diagnosticó durante el puerperio. La paciente acudió al hospital a los 22 días de puerperio, se diagnosticó una inversión uterina puerperal subaguda grado II, se realizan maniobras encaminadas a la reducción manual de la inversión con resultados insatisfactorios. Fue necesario realizar histerectomía total abdominal; se logró conservar ambos anejos y la vida de la paciente. Su tratamiento habitualmente es quirúrgico, sobre todo si no se diagnostica en el tercer estadio del parto(AU)

Obstetric uterine inversion is a rare entity, and one of the most serious complications of the third stage of labor that endangers the life of the mother. The inversion of the uterus is a change of arrangement of its walls, it pulls on the inside surface, and turns the organ inside out shaping a glove finger. It is an obstetric accident which constitutes a true emergency and causes of maternal death from hemorrhagic shock. Fortunately its incidence in our country is low, given the low number of reports on the subject. The aim of this paper is to present this case by its unusualness in clinical form which was diagnosed during the postpartum period. The patient came to the hospital at 22 days postpartum. Sub-acute puerperal uterine inversion grade II was diagnosed. Manual maneuvers were made aiming to reduce the inversion. The results were unsatisfactory. It was required total abdominal hysterectomy; we managed to keep both adnexae and the life of the patient. Treatment is usually surgical, especially if not diagnosed in the labor third stage(AU)

Non-puerperal Uterine Inversion Presented with Hypovolemic Shock

We report a non-puerperal uterine inversion with nulliparous women caused by huge pedunculated submucosal fibroid. Massive bleeding from protruding mass through vagina brought the heart to stop in 42-year-old nulliparous woman. She became cardiopulmonary resuscitation survivor in emergency room and then underwent laparotomy which ended in successful myomectomy rather than hysterectomy considering her demand for future fertility. Meticulous and adequate fluid therapy and transfusion was also administered to recover from hypovolemic status. Pathologic report confirmed benign submucosal fibroid with degeneration, necrosis and abscess formation. Thus, clinician should be aware of uterine inversion when encountered with huge protruding vaginal mass and consider uterus-preserving management as surgical option when the future fertility is concerned.

Intussuscepção uterina em uma cadela Yorkshire Terrier / Uterine intussusception in a Yorkshire terrier bitch

A intussuscepção uterina é condição rara em pequenos animais. No presente relato descreve-se um caso de intussuscepção uterina em um canino, fêmea Yorkshire Terrier no pós-parto imediato, diagnosticada por meio de laparotomia exploratória e pela avaliação anatomopatológica. Realizou-se a ovariossalpingo-histerectomia (OSH) como tratamento definitivo para a alteração. Conclui-se, portanto, que a intussuscepção uterina pode ocorrer em cadelas, de forma espontânea no pós-parto imediato.

Uterine intussusception has rarely been described in small animals. In this report we describe a case of uterine intussusception in a female Yorkshire terrier immediately postpartum, diagnosed by exploratory laparotomy and anatomopathologic evaluation. Ovariosalpingohisterectomy (OSH) was performed as definitive treatment. It is concluded that the intussusception of the uterus may occur spontaneously in dogs immediately postpartum.

Spontaneous Restoration of Unrecognized Uterine Inversion / 대한주산의학회잡지

We report a case of unrecognized uterine inversion was restored spontaneously without surgical intervention. Initially, the case was diagnosed as uterine atony and not uterine inversion and was managed successfully with uterine artery embolization. However, a partial uterine inversion was detected on a subsequent scheduled pelvic examination. Fortunately, her uterus was completely restored without any surgical intervention on eighth week after delivery.

Inversión uterina puerperal crónica / Chronic puerperal uterine inversion

La inversión uterina es una entidad clínica poco frecuente y grave, descrita como una emergencia obstétrica relacionada con las complicaciones del tercer estadio del parto que necesita tratamiento inmediato, habitualmente quirúrgico. Con este artículo se pretende demostrar a la comunidad científica algunos elementos relacionados con esta, pues es probable que por su baja incidencia, generaciones actuales de obstetras no alcancen asistir una paciente con esta complicación, además por la ausencia de reportes nacionales relacionados con esta entidad. Se presenta una paciente que acudió al hospital, a los 2 meses después del parto, se diagnosticó una inversión uterina puerperal crónica grado II, fue necesario realizar la histerectomía total como tratamiento definitivo, lograron conservarse ambos anejos. La forma de presentación atípica en el cuadro clínico de esta paciente y la posibilidad de mostrar una evidencia gráfica de su presentación clínica y tratamiento quirúrgico, motivaron la presentación de este trabajo.

Uterine inversion is a rare and severe clinical entity described related to obstetric emergency in labor third stage complications, which needs immediate treatment, usually surgery. This article aims to show the scientific community some elements related to this, since it is likely that due to its low incidence, current generations of obstetricians do not assist patients with this complication, apart from the absence of national reports related to this entity. A patient came to the hospital 2 months after delivery, A chronic puerperal uterine inversion grade II was diagnosed. Total hysterectomy was necessary to perform as definitive treatment, achieving to retain both ovaries. The atypical presentation in this patient clinical condition and the ability to display graphic evidence of its clinical presentation and surgical treatment led to the presentation of this paper.

Non-puerperal uterine inversion: A case report / Philippine Journal of Obstetrics and Gynecology

Uterine inversion is a condition in which the uterus turns inside out with the fundus prolapsing to or through the cervix. Uterine inversion is classified into puerperal or nonpuerperal. Non-puerperal uterine inversion is a rare entity with no accurate estimate regarding its incidence available to date. A case of 25 year-old primipara with a one year history of abnormal uterine bleeding is presented. Her only pregnancy was 5 years prior to admission. She delivered a term baby girl of unrecalled birth weight vaginally, with no reported intrapartal or postpartum complications. Internal examination revealed a palpable mass within the middle third of the vagina measuring 4.0cm x 4.0cm x 4.0cm, doughy, with a smooth, spongy surface, seemingly prolapsed out of a smooth dilated cervix. The uterine corpus was not appreciated on bimanual examination. The patient was diagnosed to have uterine inversion and underwent conservative surgical reduction of the uterus initially with a vaginal approach using the Kustner technique which was later converted to an abdominal repair via the Haultain procedure. Non puerperal uterine inversion can be diagnosed and successfully managed in a lowresource environment, but may require the utilization of elements from several standard techniques before reduction is accomplished.

A case of uterine inversion resulted from prolapse of huge pedunculated uterine submucosal leiomyoma / 대한산부인과학회지

Uterine leiomyomas are the most common uterine tumors. They are estimated to be present in approximately 20% of all women of reproductive age. They may be present in subserosal, intramural, or submucosal in location within the uterus, or located in the cervix, in the broad ligaments, or on a pedicle. Many studies report that the malignant potential of a preexisting uterine leiomyoma is extremely rare, occuring in less than 0.5%. Uterine leiomyomas may cause a range of syptoms, for example, severe anemia from abnormal uterine bleeding, dysmenorrhea, constipation from rectosigmoid compression, dysuria, frequency, residual sensation due to bladder compression. Patients with those symptoms or "cancer phobia" should be treated. Rare but severe symptoms associated with uterine leiomyomas are rectosigmoid compression, with intestinal obstruction, thrombophlebitis of lower extremities from venous stasis, polycythemia, ascites, severe pain from torsion and infection of prolapsed pedunculated submucosal myoma and uterine inversion from prolase of pedunculated submucosal leiomyoma. Now we report a rare case of uterine inversion resulted from prolapse of huge pedunculated uterine submucosal leiomyoma, which caused hypovolemic shock due to massive uterine bleeding.

Replacement of Uterine Inversion by the Induction of General Anesthesia: A case report / 대한마취과학회지

Uterine inversion is a rare but a potentially fatal complication of labor, and may occur in the third stage of labor. Because it can lead to shock and hemorrhage, immediate management should be attempted to replace the inverted uterus. We report a case in which uterine inversion was not replaced by manual manipulation, but which was successfully replaced by the induction of general anesthesia.