Nonpuerperal uterine inversion caused by an adenosarcoma: A case report.

INTRODUCTION: Eighty-five per cent of uterine inversions are puerperal. Non-puerperal uterine inversion is usually caused by tumours that exert a traction force on the fundus of the uterus. This causes the uterus to be partially or completely inverted. It is commonly related to benign tumours like submucosal leiomyomas. Nevertheless, malignancies are an infrequent association. CASE PRESENTATION: We report a case of a 35-year-old female patient, medically and surgically free, gravida0 para0, complaining of menometrorrhagia associated with pelvic pain for 2 years. A suprapubic ultrasound scan showed an enlarged, globular uterus with a heterogeneous, undefined mass of 49 mm in size. MRI scan showed the appearance of a U-shaped uterine cavity and a thickened inverted uterine fundus with an endometrial infiltrating mass of 25 mm. Intraoperative exploration showed uterine inversion involving the ovaries; the fallopian tubes and the round ligaments and a necrotic intracavitary mass. The malignancy of the tumor was confirmed through anatomopathological examination as Adenosarcoma. CONCLUSIONS: Uterine inversion is rare outside the puerperal period, and malignant etiology must not be overlooked. Therefore, comprehensive care with meticulous etiological investigation is crucial.

Non-Puerperal Chronic Inversion of Uterus Due to Big Fibroid Uterus in a Post-Menopausal Woman.

Uterine inversion occurs in puerperal and non-puerperal conditions; non-puerperal uterine inversion (NPUI) may run acute and chronic clinical course. Most on the NPUI are chronic variety while a few are acute variety. NPUI occurs if there is long standing big sub-mucosal fibroid and it is very rare to present in acute setting. Here we report a case of acutely presented NPUI. A 58-year-old widow of lower socioeconomic status presenting to the emergency center of Chittagong medical college Hospital with complaints of sudden protrusion of a big mass through introitus in an attempt of passing out hard stool during defecation on the day of admission with a history of per vaginal watery discharge for a long time and severe anemia. Anemia was corrected and a broad-spectrum antibiotic was given prior to operative management. Under general anesthesia vaginal myomectomy followed by vaginal hysterectomy was performed in the same sitting. Pathological examination revealed a fibroid uterus. Postoperatively patient recovered without any residual problem. Infection should be suspected and treated with appropriate broad-spectrum antibiotics before planning surgery. Vaginal route restoration of NPUI is very difficult but possible with careful attempt. During a vaginal hysterectomy, care to locate and salvage the bladder and distal urinary collecting system is warranted. So, a high index of suspicion is the key to limit morbidity and approach for proper management of such rare clinical condition.

A Rare Case Report of Successful Laparoscopy-Guided Reduction of Non-Puerperal Uterine Inversion.

Non-puerperal uterine inversion is an extremely rare and potentially dangerous condition. Cases are poorly described in the literature, and their actual incidence is unknown. A 34-year-old nulliparous female patient visited the emergency department following a loss of consciousness. She had experienced continuous vaginal bleeding over the preceding two months, with a two-day history of worsening symptoms. The patient showed signs of hypovolemic shock secondary to unceasing vaginal bleeding. Ultrasound and computed tomography revealed an inverted uterus and a large hematoma inside the patient's vaginal cavity. An emergency explorative laparoscopy was performed, which confirmed uterine inversion. Initially, Johnson's maneuver was attempted under laparoscopic visualization, but this failed to achieve uterine reduction. Following the unsuccessful performance of Huntington's maneuver, a re-trial of the manual reduction allowed the uterus to recover to its normal anatomy. The patient's vaginal bleeding was dramatically reduced after successful uterine reduction. The pathologic report conducted confirmed endometrioid adenocarcinoma. Laparoscopic visualization is a feasible and safe procedure for achieving uterine reduction in cases of non-puerperal uterine inversion with an unconfirmed pathology. Uterine malignancies should be considered in patients with non-puerperal uterine inversion.

A 63-Year-Old Postmenopausal Woman with Uterine Inversion Associated with a Submucosal Geburt Fibroid Successfully Treated by Surgical Reversal Using the Spinelli Procedure.

BACKGROUND Reproductive health affects long-term quality of life, including in the elderly. Uterine inversion is common in postpartum women in developing countries and menopausal women are also at risk. CASE REPORT A 65-year-old menopausal woman had 3 children and a history of uterine tumors and curettage. She had received a different diagnosis - a cervical tumor - exactly 3 years ago. She was admitted to a referral hospital for lower abdominal pain, difficulty in defecating, and a mass in the genitals when straining, accompanied by blood clots. There was a 20×20 cm mass protruding from the vagina, and the uterine fundus of the uterus was not palpable. The patient was diagnosed with chronic uterine inversion due to submucous leiomyoma. Management requires the collaboration of multidisciplinary professionals in hospitals. These patients receive therapy to improve their general condition, transfusions, antibiotics, and a hysterectomy plan. The results of the Urogynecology Division showed that a 20×15 cm mass came out of the vagina, with a large necrotic area. The patient was first managed by Spinelli procedure to correct the uterine inversion, followed by an abdominal hysterectomy. Histopathology revealed the final diagnosis as a benign mesenchymal lesion, leiomyoma with myxoid degeneration. CONCLUSIONS Timely diagnosis and management by a multidisciplinary team can help reduce morbidity and mortality in patients with submucosal uterine leiomyoma leading to chronic uterine inversion.

Complete non-puerperal uterine inversion caused by uterine hemangioma: about a case report.

Uterine inversion is a rare postpartum complication. It is a rare condition in which the internal surface of the uterus protrudes through the vagina. Non-puerperal uterine inversion (NPUI) is extremely rare. In most instances, it is linked to uterine tumors. Among these tumors, leiomyoma is the most frequent cause reported in data. This condition may not be noticed until time of surgery. Malignancy is suspected in most cases. Nevertheless, uterine inversion can be diagnosed preoperatively using radiology. Difficulties in diagnosing NPUI makes this clinical case a challenge in gynaecology and not commonly reported in literature. We report our experience in the diagnosis and treatment of a complete non-puerperal uterine inversion associated with uterine angioleiomyoma. The patient's age was 44, gravida 2 para 1 presented with intermittent vaginal bleeding for four months and an acute abdominal cramping pain. On examination, a large mass lesion was observed which occupies the vaginal cavity and the contour of the uterine cervix could not be reached. Biopsies and Immunohistochemistry matched with an angioleiomyoma. She underwent a transvaginal surgical reposition technique: Spinelli's. It is important to diagnose accurate non-puerperal uterine inversion. Surgery provides good prognosis and it is necessary. We report a case of NPUI caused by angioleiomyoma. Nevertheless, malignancy must be eliminated in first place.

Akutt uterusinversjon.

BACKGROUND: Acute uterine inversion is a rare, but serious, obstetric complication in the third stage of labour, commonly resulting in significant morbidity and mortality. A total or partial invagination of the uterine fundus occurs, followed by profuse bleeding and circulatory instability. The case presented here illustrates a typical clinical course of the condition. CASE PRESENTATION: After giving birth to a large, healthy boy, a woman developed acute uterine inversion. The uterus was successfully repositioned using Johnson's manoeuvre under general anaesthesia, and significant transfusion was needed to combat the resulting haemorrhage. INTERPRETATION: Acute inversion of the uterus should be suspected based on purely clinical signs. Treatment should commence without delay by a multidisciplinary team of obstetricians, anaesthesiologists and surgeons.

Acute non-puerperal uterine inversion ascribed to malignant mixed Mullerian tumor of uterus: a rare presentation.

Non-puerperal uterine inversion is an extremely uncommon condition, and its occurrence due to malignant mixed Mullerian tumor (MMMT) of the uterus is quite exceptional. We report one such case of acute non-puerperal uterine inversion ascribed to MMMT in a 77-year-old postmenopausal woman. Such a case poses a diagnostic and management dilemma, and prior knowledge may result in a successful outcome.

[Inversio uteri is a rare but potentially lethal obstetric complication].

A case of puerperal uterine inversion is, in this case report, presented in a low risk 29-year-old para 2. After a difficult manual removal of placenta, the patient became disproportionally hypovolaemic shocked compared to blood loss. When the diagnosis was recognized, uterus was reverted, and bleeding ceased momentarily. The precise aetiology of uterine inversion is not known, but factors such as prolonged duration of labour, abnormal placentation and manipulation of third stage of labour have been proposed. The severity and unpredictable nature emphasize the importance of every birth attendant being aware of this condition.

Non-puerperal Uterine Inversion with endometrial polyps in an 11-year-old girl: A Case Report.

BACKGROUND: Non-puerperal uterine inversion is a rare condition with diagnostic and surgical challenges. Clinically, the inverted uterus appears as a mass protruding from the vagina and is often misdiagnosed as a malignant tumor and surgically removed. CASE: An 11-year-old girl was admitted to the emergency room due to spontaneous vaginal mass protrusion. The pudendum examination showed an irregular and dark red neoplasm protruding from the vagina. The final diagnosis was non-puerperal uterine inversion with an endometrial polyp. SUMMARY AND CONCLUSION: MRI is the key to the diagnosis of uterine inversion. Our review confirmed that the 11-year-old girl was the youngest in the world to suffer from non-puerperal uterine inversion.

Uterine rhabdomyosarcoma complicated by cerebral venous thrombosis and uterine inversion in a young woman: case report and literature review.

BACKGROUND: Uterine rhabdomyosarcoma is an extremely rare malignant tumor that usually affects young women and has a poor prognosis. CASE PRESENTATION: A 19-year-old nulliparous woman presented to the emergency department under sedation due to seizures. Imaging examination revealed cerebral venous thrombosis. During thrombolytic therapy, she developed vaginal bleeding followed by uterine inversion secondary to uterine rhabdomyosarcoma. The inverted uterus was mistaken for a cervical tumour and was removed vaginally. The patient's disease progressed despite chemotherapy with vincristine, actinomycin D and cyclophosphamide and she died within 6 months. To our knowledge, this is the first case of uterine rhabdomyosarcoma complicated with cerebral venous thrombosis. CONCLUSIONS: Malignancy is an important diagnostic in patients with cerebral venous thrombosis with no obvious cause. This case demonstrates the importance of considering uterine neoplasms in the differential diagnosis of adolescent girls with abnormal uterine bleeding. Further, careful anatomical evaluation of vaginal masses should be performed prior to surgical intervention.

[Acute Puerperal Uterine Inversion: A Case Report]. / Akute Inversio uteri puerperalis: Eine Falldarstellung.

Puerperal inversion of the uterus is a rare but life-threatening obstetric complication. Unrecognized, it can lead to severe bleeding and shock and even maternal death. Manual replacement under general anesthesia is usually successful. If the manual replacement fails, surgical replacement by laparotomy needs to be performed. In any case, mortality and morbidity can be reduced by rapid recognition and immediate replacement. Therefore, regular practical exercises for the detection and treatment of acute uterine inversion as well as other obstetric emergencies should be performed as part of medical training. We would like to report of a 31-year-old Gravida 2 Para 0 at 39 weeks+4 days of gestation who, after an uncomplicated spontaneous vaginal delivery, had an acute third-degree uterine inversion, which was replaced by laparotomy after an unsuccessful vaginal replacement attempt.

Postnatal inversion of the uterus - management in specific cases.

Inversion of the uterus is defined as the turning inside out of the fundus into the uterine cavity. According to the literature, uterine inversion occurs in 1/20,000 or even 1/1,584 deliveries. Mortality rates following acute uterine inversion were reported by some authors to have been as high as 80%. Therefore, it is very important to make an early diagnosis. The shorter the time between the moment of uterine inversion and its repositioning, the better the results of conservative treatment, and bigger chance of avoiding surgical management. The article presents two cases of patients hospitalised in 2010 - 2011 in the Gynaecologic and Obstetrics Department of the Regional Polyclinic Hospital in Kalisz, Central Poland, diagnosed with acute uterine inversion in accordance with the applicable classification. Surgical management was applied in one of the patients. The other patient was managed in a conservative manner. Both women were discharged from the hospital in a good general condition.

Complete non-puerperal uterine inversion caused by uterine hemangioma: A case report.

OBJECTIVE: Uterine inversion is a rare postpartum complication. Non-puerperal uterine inversion is extremely rare. It mostly occurs with uterine tumors, especially leiomyoma. In most instances, the inversion may not be noticed until the time of surgery. The preoperative diagnosis is difficult. CASE REPORT: We report a case of non-puerperal complete uterine inversion that was initially diagnosed as cervical cancer. The uterine inversion was diagnosed preoperatively and she underwent total abdominal hysterectomy and bilateral salpingooophorectomy. The histological examination showed uterine hemangioma. CONCLUSION: Accurate diagnosis of the non-puerperal uterine inversion is important. Surgical intervention is necessary and it provides good prognosis. Hemangioma may be one of the causes of non-puerperal uterine inversion.

Chronic uterine inversion with malignancy mimicking carcinoma cervix.

Chronic non-puerperal uterine inversion is a rare event, with only a handful of cases reported in literature. We report a case of a 64-year-old postmenopausal woman who presented with complaints of mass per vaginam and postmenopausal bleeding. On examination, she appeared to have third-degree cervical descent with an irregular growth seen over what appeared to be the cervix, biopsy of which showed keratinising squamous cell carcinoma. Subsequently, an inverted uterus was diagnosed at laparotomy with an irregular growth seen over the inverted portion of the uterine fundus, histopathology of which revealed squamous cell carcinoma of endometrium.

Uterine Inversion as a Result of a Large Prolapsed Carcinosarcoma of the Uterus.

BACKGROUND: Uterine inversion is most commonly seen in labour and delivery. However, it can be associated with uterine tumours, including gynaecologic malignancy. CASE: In a 66-year-old woman, uterine inversion identified at laparotomy that was found to be associated with uterine carcinosarcoma (malignant mixed mesodermal tumour) represents an unusual presentation. Surgical approach necessitated a vertical hysterotomy to amputate and deliver the uterine tumour. CONCLUSION: Uterine inversion in gynaecologic oncology may be associated with sarcoma or malignant mixed mesodermal tumour. This can represent a diagnostic and surgical challenge and should be considered.

Uterine Inversion: A Review of a Life-Threatening Obstetrical Emergency.

IMPORTANCE: Uterine inversion is frequently accompanied by postpartum hemorrhage and hypovolemic shock. Morbidity and mortality occur in as many as 41% of cases. Prompt recognition and management are of utmost importance. OBJECTIVE: The aim of this review is to describe risk factors, clinical and radiographic diagnostic criteria, and management of this rare but potentially life-threatening complication of pregnancy. EVIDENCE ACQUISITION: A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched. RESULTS: There were 86 articles identified, with 25 being the basis of review. Multiple risk factors for a uterine inversion have been suggested including a morbidly adherent placenta, short umbilical cord, congenital weakness of the uterine wall or cervix, weakening of the uterine wall at the placental implantation site, fundal implantation of the placenta, uterine tumors, uterine atony, sudden uterine emptying, fetal macrosomia, manual removal of the placenta, inappropriate fundal pressure, excessive cord traction, and the use of uterotonic agents prior to placental removal. The diagnosis is almost exclusively clinical, and successful treatment depends on prompt recognition of the uterine inversion. Treatment options include manual and surgical replacement of the inverted uterus. There is no consensus regarding mode of delivery in subsequent pregnancies as reinversion in a subsequent pregnancy is unpredictable. However, if surgical replacement was required in the index pregnancy and involved an incision into the contractile portion of the uterus, cesarean delivery is a reasonable management option similar to that offered for a prior classic cesarean section. CONCLUSIONS: Successful treatment is dependent on prompt recognition. Management should include resuscitation of maternal hypovolemic shock, as well as repositioning of the inverted uterine fundus. RELEVANCE: Uterine inversion is a rare but potentially life-threatening obstetrical emergency.

[Uterine inversion: about a case]. / Inversion utérine: à propos d'un cas.

Uterine inversion is a rare but potentially serious complication of labour characterized by "glove-finger" introflexion of the uterine body protruding into the vagina or out of the vulva. This disease commonly occurs just after delivery and it is characterized by severe pain associated with hemorrhagic shock. The diagnosis is essentially based on clinical examination and must be immediate in order to allow quick reinversion before the formation of a constriction ring. Mortality rate is low if patients are early diagnosed and treated. Uterine inversion does not seem to affect the obstetrical prognosis. Contributing factors mainly include uterine hypotonia associated with fundal placenta causing depression of the uterine fundus in case of inappropriate maneuvers (pulling on the umbilical cord, uterine expression). Reinversion should be quick associated with resuscitation measures (shock resuscitation). It is based on several manual methods consisting of returning the uterus after possible muscle relaxants treatment (nitrated derivatives, betamimetics and general anesthesia). Failure results in surgical treatment using high or low approach. We report the case of total uterine reinversion during delivery by cesarean section.

[Chronic non-puerperal uterine inversion: about a case]. / Inversion utérine non puerpérale chronique: à propos d'un cas.

Chronic non puerperal uterine inversion is an extremely rare clinical condition. Puerperal inversion occurs in 85% of cases exposing women to the risk of postpartum cataclysmic hemorrhage. We here report the case of a 70-year old patient presenting with urogenital prolapse Stage III. Total double-approach hysterectomy without adnexal conservation was performed: vaginal approach complemented by laparotomy showing uterine inversion with bilateral adnexa pulled into the inversion. Abdominal approach allowed good surgical exposure, exclusion of gastrointestinal or urinary contents drawn into the inversion before hysterectomy. Although rare and difficult to diagnose, acute non-puerperal uterine inversion is a medical-surgical emergency.

Inversión uterina puerperal. A propósito de un caso / Puerperal uterine inversion: report of a case

La inversión uterina puerperal es una complicación grave y poco frecuente que supone una verdadera emergencia obstétrica. La matrona debe conocer sus signos y síntomas y saber cómo actuar si se presenta esta situación. A continuación se expone un caso clínico de una inversión uterina que tuvo lugar en enero de 2015 en el Hospital de Mérida (Badajoz) (AU)

Puerperal uterine inversion is a serious and rare complication that means a true obstetric emergency. The midwife must know its signs and symptoms and how to act if this situation happens. A case of uterine inversion that took place in January 2015 in the Hospital de Mérida (Badajoz) will be exposed below (AU)

Non-puerperal uterine inversion due to submucous myoma in a woman: a case report.

Uterine leiomyomas are the most common benign tumor of the female reproductive tract. Their incidence during pregnancy is approximately 2 percent and they are associated with some complications such as preterm labor, placental abruption, fetal malpresentation, obstructed labor, cesarean delivery, and postpartum hemorrhage. They may develop anywhere within the muscular wall of the uterus, including submucosal, intramural, or subserosal areas. Some of the submucous myomas may be pedunculated and eventually may protrude through the cervical canal to the vagina. They later become necrotic and sometimes infected. Vaginal myomectomy is recommended as the initial treatment of choice for a prolapsed, pedunculated myoma except when other indications require an abdominal procedure. Inversion is a condition in which the uterus turns inside out with prolapse of the fundus through the cervix. It is seen in acute and chronic forms. Chronic inversion may follow an incomplete obstetric inversion unnoticed or left uncared. Herein, we present, a case of infected non-puerperal uterine inversion due to submucous leiomyoma that was originating from fundus and the diagnostic dilemma it presents in the after puerperal stage.