López HMA, García JG, González MPF, Concha MRA, García CE, Carmona OVH

Language: Spanish
References: 18
Page: 23-31
PDF size: 227.76 Kb.

ABSTRACT

Background: Uterine inversion, also known as uterine intussusception, is characterized by the protrusion of the uterine fundus through the vagina, either partially or completely, and occurs in 1 out of 30,000 deliveries. Non-puerperal uterine inversion is considered a rare complication, with only a few case series reported in the literature and no estimate of its incidence. Its main cause is uterine leiomyomas, which account for 85% of cases, typically presenting with symptoms such as vaginal bleeding and severe pelvic pain, which can become complicated and potentially life-threatening, making its management a significant challenge. A high index of clinical suspicion is required for its timely diagnosis.
Case report: A 35-year-old female patient presented to the emergency room with acute, severe, colicky pain in the lower abdomen, accompanied by heavy vaginal bleeding, a sensation of a foreign body in the vaginal canal, and hemodynamic instability. Vaginal examination revealed a mass protruding 2 cm below the vaginal opening. During clinical management, the patient developed severe hemodynamic instability, leading to severe hypovolemic shock that required intensive care. Once stabilized, surgical intervention was performed. During laparotomy, a complete uterine inversion was found; abdominal hysterectomy was performed, with a satisfactory outcome.
Surgical findings: Uterus measuring 10 × 8 × 8 cm with an inverted fundus, pedicles at the level of the vesicouterine fold, ovaries and fallopian tubes without macroscopic abnormalities. A cervical leiomyoma measuring 14 × 14 × 10 cm, with 100 cc of bleeding and weighing 350 g.
Conclusion: Non-puerperal uterine inversion, being an uncommon condition with a variable clinical presentation, is difficult to diagnose, leading to delays in appropriate treatment and potentially endangering the patient’s life. A thorough medical history is essential for a timely diagnosis. Cases like this help us better understand the condition and adopt a more appropriate treatment approach.

REFERENCES

1. Grandin EH, Bandl L, Billroth T, et al. Cyclopaedia ofobstetrics and gynecology. [Internet]. New York: W. Wood& Company; 1887. p. 404. [modificado 18 enero 2022;consultado 10 febrero 2025]. Disponible en: http://archive.org/details/cyclopdiaofobs02gran

2. Herath RP, Patabendige M, Rashid M, et al. Nonpuerperaluterine inversion: what the gynecologists need to know?Obstet Gynecol Int. 2020;2020:8625186. Disponible en:https://doi.org/10.1155/2020/8625186

3. Martínez-Rodríguez JJ, Velázquez-Castellanos PI, López-Ruiz JM, et al. Inversión uterina total secundaria a leiomiomasubmucoso. Ginecol Obstet Mex. 2021;89(1):58-70.Disponible en: https://doi.org/10.24245/gom.v89i1.4398

4. Gomez-Lobo V, Burch W, Khanna PC. Nonpuerperaluterine inversion associated with an immature teratoma ofthe uterus in an adolescent. Obstet Gynecol. 2007;110(2Pt 2):491-3. Disponible en: https://doi.org/10.1097/01/AOG/0000262898.96160.16

5. Della Corte L, Giampaolino P, Fabozzi A, et al. An exceptionaluterine inversion in a virgo patient affected bysubmucosal leiomyoma: case report and review of the literature.J Obstet Gynaecol Res. 2019;45(2):466-72. Disponibleen: https://doi.org/10.1111/jog.13806

6. Montañez MA, Arévalo S, Arias-Duarte ML, et al. Inversiónuterina no puerperal en paciente con leiomioma uterino:caso clínico. Rev Chil Obstet Ginecol. 2024;89(1):43-7. Disponibleen: http://dx.doi.org/10.24875/rechog.23000055

7. Zaki-Metias KM, Hosseiny M, Behzadi F, et al. Uterineinversion. Radiographics. 2023;43(6):e230004. Disponibleen: https://doi.org/10.1148/rg.230004

8. Wang W, Wang J. Uterine inversion secondary to endometrialcarcinoma. J Med Cases 2023;14(1):7-12. Disponibleen: doi: https://doi.org/10.14740/jmc4023

9. Li F, Liang Y, Luo M, et al. A rare case of endometrial polypcomplicated with uterine inversion: a case report andclinical management. Open Med (Wars). 2022;17(1):550-5. Disponible en: https://doi.org/10.1515/med-2022-0425

10. Kesrouani A, Cortbaoui E, Khaddage A, et al. Characteristicsand outcome in non-puerperal uterine inversion.Cureus. 2021;13(3):e13345. Disponible en: https://doi.org/10.7759/cureus.13345

11. Montañez MA, Arévalo S, Arias-Duarte ML, et al. Inversiónuterina no puerperal en paciente con leiomioma uterino:caso clínico. Rev Chil Obstet Ginecol 2024;89(1):43-7. Disponibleen: http://dx.doi.org/10.24875/rechog.23000055

12. Song YJ, Yang J, Yun HS, et al. Non-puerperal uterineinversion presented with hypovolemic shock. J MenopausalMed. 2016;22(3):184-7. Disponible en: https://doi.org/10.6118/jmm.2016.22.3.184

13. Mariana L, Margarida NS, Campos M, et al. Nonpuerperaluterine inversion presenting with hemorrhagic shock.AJOG. 2024;230(6):663-9. Disponible en: https://doi.org/10.1016/j.ajog.2024.06.029

14. Guarino M, Perna B, Cesaro AE, et al. Update on sepsisand septic shock in adult patients: management in theemergency department. J Clin Med. 2023;12(9):3188. Disponibleen: https://doi.org/10.3390/jcm12093188

15. Leconte I, Thierry C, Bongiorno A, et al. Non-puerperaluterine inversion. J Belg Soc Radiol. 2016;100(1):97. Disponibleen: https://doi.org/10.5334/jbr-btr.974

16. Foti PV, Tonolini M, Costanzo V, et al. Cross-sectionalimaging of acute gynaecologic disorders: CT and MRIfindings with differential diagnosis—part II: uterine emergenciesand pelvic inflammatory disease. Insights Imaging.2019;10:118. Disponible en: https://doi.org/10.1186/s13244-019-0807-6

17. Guerrouj I, Aichouni N, Haddar L, et al. Magnetic resonanceimaging of non-puerperal total uterine inversiondue to a leiomyoma. Radiol Case Rep. 2023;18(6):1821-4.Disponible en: https://doi.org/10.1016/j.radcr.2023.01.093

18. Shasindran R, Dharshini N, Aruku N, et al. Exploringnon-puerperal uterine inversion: a case series. Cureus.2024;16(1):e53071. Disponible en: https://doi.org/10.7759/cureus.53071