Acute non peurperal uterine inversion caused by leiomyma associated with precancerous lesions: A case report

Abstract

Acute non-puerperal uterine inversion (Acute NPUI) is a rare clinical entity that is usually associated with a polypoid uterine tumor, usually a leiomyoma, but its occurrence due to combined leiomyoma with precancerous lesions is quite exceptional. Here, the authors present the case of a 65-year-old woman who was diagnosed with acute NPUI as an unusual complication of prolapsed fibroid. On abdominal examination, palpation of the lower abdomen was very painful. On pelvic examination, a huge hemorrhagic mass was noticed, with necrotic areas protruding at a level 10 cm above the introitus. The cervix could not be palpated or visualized, and the uterus was difficult to appreciate on a bimanual examination due to tenderness. By transabdominal sonography, the uterus could not be clearly identified. Routine blood tests were completely normal, including hemoglobin concentrations. First of all, we manually replaced the inverted uterus in its normal position and then performed a total hysterectomy and a bilateral adnexectomy. Pathological findings demonstrated a leiomyoma with areas of complex hyperplasia with atypia! When we encounter a case of non-puerperal uterine inversion, we must consider fibroids as the most common cause, and we must act quickly so that the patient does not go into neurogenic shock and die. Although leiomyoma is the most common cause of NPUI, a pathological study should be performed in all cases.