Uterus-sparing laparoscopic reversal of complete nonpuerperal uterine inversion: a rare case and challenging procedure

IF 8.1 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Fertility and sterility Pub Date : 2026-10-01 Epub Date: 2026-07-01 DOI:10.1016/j.fertnstert.2026.06.030

Athanasios Protopapas Ph.D., Nikolaos Kathopoulis Ph.D., Athanasios Douligeris M.D., Kyveli Aggelou M.D., Ioannis Chatzipapas Ph.D., Konstantinos Kypriotis M.D.

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引用次数: 0

Abstract

Objective

To present а rare case of complete uterine inversion in a nonpregnant young woman who was managed successfully laparoscopically.

Design

Video article with intraoperative narration and key surgical highlights.

Subjects

A 24-year-old patient with a history of laparotomic staging for a granulosa-cell ovarian tumor was admitted as an emergency to the gynecological oncology department of our hospital, with sudden onset of intractable uterine bleeding, caused by a necrotic, hemorrhagic mass, protruding from the vagina.

Exposure

Transvaginal excision of the lesion was attempted under laparoscopic control. At laparoscopy, complete uterine inversion was found. Μaneuvers to correct the inversion were unsuccessful. Hemostatic sutures were placed, and the patient was referred to our unit for further management. Histopathology suggested uterine adenomyoma. The uterine inversion was successfully reversed with a combination of laparoscopic and vaginal maneuvers after vertical anterior and posterior uterine incisions to divide the cervical constriction ring. The uterine cavity was opened, previous sutures were removed, and the uterus was reconstructed with resuturing in two layers. A prophylactic cervical cerclage tape was placed laparoscopically.

Main Outcome Measures

Anatomical restoration of the uterus.

Results

At the six-month follow-up, the patient reported irregular cycles, without menorrhagia, and had a fairly normal-shaped uterus.

Conclusion

Successful laparoscopic management of uterine inversion in nonpregnant patients with fertility preservation has been rarely reported. It represents a most challenging procedure when uterine preservation is at stake.

Download: Download video (110MB)

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保留子宫的腹腔镜完全非产褥期子宫反转：一个罕见的病例和具有挑战性的程序！

目的介绍一例罕见的未怀孕的年轻女性完全子宫内翻，并成功地进行腹腔镜手术。DESIGNVideo文章，包含术中叙述和关键手术要点。研究对象：一名24岁的卵巢颗粒细胞瘤剖腹手术分期患者，因突发性难治性子宫出血，由阴道外突出的坏死出血性肿块引起，作为急诊科收治。暴露在腹腔镜控制下尝试经阴道切除病变。腹腔镜检查发现子宫完全内翻。Μaneuvers矫正反转均未成功。止血缝线放置，并将患者转至我科进行进一步治疗。组织病理学提示子宫腺肌瘤。子宫内翻成功逆转，腹腔镜和阴道联合操作后，垂直子宫前后切口分割宫颈收缩环。切开子宫腔，拆除之前的缝合，分两层重新缝合重建子宫。腹腔镜下放置预防性宫颈环扎带。主要观察指标：子宫解剖恢复。结果随访6个月，患者月经周期不规则，无月经过多，子宫形态相当正常。结论腹腔镜下成功治疗保留生育能力的非妊娠患者宫内翻的报道很少。当子宫保存受到威胁时，这是一项最具挑战性的手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Fertility and sterility 医学-妇产科学

CiteScore

11.30

自引率

6.00%

发文量

1446

审稿时长

31 days

期刊介绍： Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.