scholarly journals Management of Nonpuerperal Uterine Inversion Using a Combined Vaginal and Abdominal Approach

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Ferid A. Abubeker ◽  
Mulugeta Misgina ◽  
Ahmed Ebabu ◽  
Eyerusalem Fekade ◽  
Biruck Gashawbeza
Keyword(s):  
Clinical Diagnosis ◽  
Imaging Techniques ◽  
Power Doppler ◽  
Surgical Techniques ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Clear Understanding ◽  
Uterine Inversion ◽  
Abdominal Approach ◽  
3D Power Doppler

Introduction. Nonpuerperal uterine inversion is an extremely rare clinical condition. As such, some cases will have to be managed without prior experience. Clinicians must have a high index of suspicion to make the diagnosis and a clear understanding of the principles of recommended surgical techniques. Here, we report a case of nonpuerperal uterine inversion managed using a combined vaginal and abdominal approach. Case Presentation. A 70-year-old postmenopausal woman presented with profuse vaginal bleeding and protruding mass per vagina. Examination showed a solitary globular mass attached to an inverted uterus. A clinical diagnosis of nonpuerperal uterine inversion was made. A vaginal approach was used to first remove the mass followed by an abdominal approach to reposition the uterus using the Haultain procedure. Subsequently, total abdominal hysterectomy with bilateral salpingo-oophorectomy was done without complication. Histologic examination showed myoma with adenomyosis. Conclusion. Advanced imaging techniques such as 3D power Doppler and MRI have signature signs to confirm the clinical diagnosis of uterine inversion. Short of these diagnostic modalities, however, carefully conducted clinical examination including examination under anesthesia, and pelvic ultrasonography can be valuable tools to reach at a diagnosis. A combined vaginal and abdominal surgical approach can facilitate repositioning and/or hysterectomy when there is a large protruding vaginal mass.

scholarly journals A rare case of acute non-puerperal uterine inversion due to large leiomyoma in COVID pandemic: challenges in clinical diagnosis and management

2020 ◽  
Vol 9 (11) ◽  
pp. 4765
Author(s):  
Snehal G. Murde ◽  
Rohini R. Raut ◽  
Beena Kumari ◽  
Dinesh C. Hojai
Keyword(s):  
Clinical Diagnosis ◽  
Rare Case ◽  
Elective Surgery ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Clinical Scenario ◽  
Clinical Exposure ◽  
Atypical Symptoms ◽  
Uterine Inversion

Non puerperal uterine inversion is a very rare clinical scenario with very few gynaecologist actually managing it in their lifetime. Acute variety of non-puerperal inversion is even rarer and thus possess diagnostic and management challenges. Case study of a rare case of a 45 years old female who was admitted for an elective surgery and had sudden acute inversion of uterus which was clinically diagnosed. Patient was managed by debulking of tumour which turned out to be large leiomyoma, followed by total abdominal hysterectomy. Rarity of the disease, atypical symptoms and less clinical exposure to such cases pose diagnostic as well as surgical challenges as in our case.

scholarly journals Towards uterine inversion: Illustration of a gradual process through three cases of submucous myoma

1970 ◽  
Vol 1 (2) ◽  
pp. 51-54
Author(s):  
Kesang D Bista ◽  
Ashma Rana ◽  
Geeta Gurung ◽  
Neelam Pradhan ◽  
Archana Amatya
Keyword(s):  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Menopausal Woman ◽  
Post Menopausal Woman ◽  
Submucous Myoma ◽  
Uterine Inversion ◽  
Gradual Process ◽  
Post Menopausal ◽  
Uterine Fundus ◽  
Vaginal Myomectomy

How the largest of the large (> 10 x 8 cms) sub mucous myoma arising from the fundus uteri successively promotes the occurrence of non puerperal uterine inversion over the years as depicted through 3 different illustrations imitating a gradual process; first by forming an indentation in the uterine fundus then progressively causing more dimpling in the verge of uterine inversion until finally giving rise to a full blown picture of complete uterine inversion where the uterine fundus is driven beyond the level of introitus with the consequences of prolapsed incarcerated myoma in a post menopausal woman. A total abdominal hysterectomy and bilateral salpingoophorectomy were performed on all of these 3 women 2 perimenopausal and a postmenopausal; the latter was first facilitated by vaginal myomectomy further supplemented by division of the inversion ring posteriorly as described by Haultain. Key words: Non puerperal uterine inversion, submucous fundal myoma, vaginal myomectomy. doi:10.3126/njog.v1i2.2398 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 51-54 Nov-Dec 2006

scholarly journals Vesico-Vaginal Fistula Repair Through Abdominal Approach

KYAMC Journal ◽  
2020 ◽  
Vol 11 (3) ◽  
pp. 129-132
Author(s):  
Hafiz Al Asad ◽  
Asif Yazdani ◽  
Zulfia Zinat Chowdhury ◽  
Muhammad Faruk Hussain ◽  
AKM Shahadat Hossaion ◽  
...  
Keyword(s):  
Wound Infection ◽  
Operative Time ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Pelvic Surgery ◽  
Vaginal Fistula ◽  
Abdominal Approach ◽  
History Of ◽  
Vesico Vaginal Fistula

Background: Vesico-Vaginal Fistula (VVF) is a major cause for concern in many developing countries with significant morbidity. Among the different techniques abdominal approach of VVF repair is important one. Objective: To find out the outcome of VVF repair by abdominal approach. Materials and Methods: It is a prospective study. Twenty-three patients with VVF were operated with abdominal approach from the period of January 2016 to January 2019. Age of patients, co-morbidities, cause, size and location of VVF were evaluated. Then abdominal approach of VVF repair was done. Operative time and need of blood transfusion were encountered. Post operative (POD) urine leakage, wound infection or other complications were enlisted. Patients were discharged with keeping urethral catheter for 14 days. Follow up was done after 1 and 3 month and in each follow up history and physical examination was done. All collected data were evaluated. Results: Mean age of the patient was 40 years. Among the 23 patients 12 (52%) patients had history of total abdominal hysterectomy, 9 had history of caesarian section and 2 cases had history of pelvic surgery. VVF repair was done at least 12 weeks after its occurrence. Operative time ranged from 90 minutes to 150 minutes. In the immediate POD no obvious complications were noted except one patient developed wound infection on 7th POD. Follow-up done as per schedule and no recurrence of VVF noted. Conclusion: VVF repair through abdominal approach is a feasible, safe and effective technique if performed meticulously. KYAMC Journal Vol. 11, No.-3, October 2020, Page 129-132

scholarly journals Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know?

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
R. P. Herath ◽  
M. Patabendige ◽  
M. Rashid ◽  
P. S. Wijesinghe
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Surgical Techniques ◽  
Clinical Problem ◽  
Abdominal Hysterectomy ◽  
Uterine Inversion ◽  
Surgical Access ◽  
Surgical Methods ◽  
Presentation Methods

Introduction. Nonpuerperal uterine inversion (NPUI) is a rare clinical problem with diagnostic and surgical challenges. The objective of our study was to review the literature on NPUI and describe causative pathologies, diagnosis, and different surgical options available for treatment. Materials and Methods. A comprehensive literature review was carried out on MEDLINE and Google Scholar databases to look for NPUI using the term “non-puerperal uterine inversion,” and further went through the cross-references of the published articles. Data are published case reports from 1911 to September 2018. Of the 153 published cases, 133 reports had adequate details of surgery for analysis. These reports were analyzed, concerning the clinical presentation, methods of diagnosis, and surgical treatment. Results. Mean age of the women was 46.3 years (standard deviation: 18, N = 153). Leiomyoma remained the commonest (56.2%) aetiology. While malignancies contributed to 32.02% of cases, 9.2% were idiopathic. High degree of clinical suspicion and identification of unique features on ultrasonography and magnetic resonance imaging enable prompt diagnosis. In cases of uncertainty, laparoscopy or biopsy of the mass was used to confirm the diagnosis. Hysterectomy or repositioning and repair of the uterus are the only treatment options available. The surgical methods implemented were analyzed in three aspects: route of surgical access, method of repositioning, and final surgical procedure undertaken. The majority (48.8%) had only abdominal access, while 27.1% had both abdominal and vaginal access. Haultain procedure was the most useful procedure for reposition (18.0%) of the uterus. The majority (39.7%) required abdominal hysterectomy with or without debulking of the tumour abdominally, while 15.0% had uterine repair after repositioning. We reviewed the different surgical techniques and described and proposed a treatment algorithm. Conclusions. Fibroids were the commonest cause for NPUI. Malignancies accounted for one-third of cases. A combined abdominal and vaginal approach, followed by hysterectomy or repair after repositioning, seems to be better for nonmalignant cases.

scholarly journals Subacute uterine inversion following an induced abortion in a teenage girl: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Asiphas Owaraganise ◽  
Leevan Tibaijuka ◽  
Joseph Ngonzi
Keyword(s):  
Rare Complication ◽  
Hypovolemic Shock ◽  
Lower Abdominal Pain ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Unsafe Abortion ◽  
Axillary Temperature ◽  
Uterine Inversion ◽  
History Of ◽  
Failed Surgery

Abstract Background Subacute uterine inversion is a very rare complication of mid-trimester termination of pregnancy that should be considered in a situation where unsafe abortion occurs. Case presentation We present a case of subacute uterine inversion complicated by hypovolemic shock following an unsafe abortion in a 17-year-old nulliparous unmarried girl. She presented with a history of collapse, mass protruding per vagina that followed Valsalva, and persistent lower abdominal pain but not vaginal bleeding. This followed her second attempt to secretly induce an abortion at 18 weeks amenorrhea. On examination, she was agitated, severely pale, cold on palpation, with an axillary temperature of 35.8 °C, a tachycardia of 143 beats per minute and unrecordable low blood pressure. The abdomen was soft and non-tender with no palpable masses; the uterine fundus was absent at its expected periumbilical position and cupping was felt instead. A fleshy mass with gangrenous patches protruding in the introitus was palpated with no cervical lip felt around it. We made a clinical diagnosis of subacute uterine inversion complicated with hypovolemic shock and initiated urgent resuscitation with crystalloid and blood transfusion. Non-operative reversal of the inversion failed. Surgery was done to correct the inversion followed by total abdominal hysterectomy due to uterine gangrene. Conclusion Our case highlights an unusual presentation of subacute uterine inversion following unsafe abortion. This case was managed successfully but resulted in significant and permanent morbidity.

scholarly journals Non-Puerperal Uterine Inversion in a Nulliparous Woman with no Uterine Mass: A Case Report and a Literature Review

2020 ◽  
Vol 5 (8) ◽  
Keyword(s):  
Rare Condition ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Nulliparous Woman ◽  
Future Research ◽  
Uterine Inversion ◽  
Uterine Muscle ◽  
General Weakness ◽  
Multiparous Women ◽  
Long Time

Background: Non-puerperal uterine inversion (NPUI) is an extremely rare condition. Most reported cases of uterine inversion ware in multiparous women. Moreover, non-puerperal uterine inversion usually occurs when there is a benign or malignant uterine mass present. In literature, there have been only 9 reported cases of non-puerperal uterine inversion in a nulliparous woman in the 10 year window from 2006 to 2017 [1]. Case: Here, a case of non-puerperal uterine inversion is discussed. Initially the patient was diagnosed as a sub-mucosal fibroid of the uterus. The diagnosis of Non-puerperal uterine inversion was made only during operation. But the case reported in this paper, is the first reported case in a patient who did not have any uterine mass and also was nulliparous. At first, an attempt to reposition the uterus was made by Huntington method but was failed. Then, it was decided to perform the total abdominal hysterectomy. Her postoperative period was uneventful and she was discharged without complication after only seven days. Conclusion: Non-puerperal uterine inversion is rarely encountered by Gynecologist. However, the rare occurrence of this case is often difficult to diagnose, especially when the exact cause of the condition is not known preoperatively. Our patient was lean, thin and malnourished, suffered from general weakness for long time. Could the weakness of the uterine muscle and ligaments be the cause for inversion? The reported case provides an indication for future research on the causes of nonpuerperal uterine inversion, specifically the scenario which has no association to uterine mass in a nulliparous woman.

scholarly journals Bilateral serous papillary adenocarcinoma of fallopian tube: a case report

2017 ◽  
Vol 4 (5) ◽  
pp. 1483
Author(s):  
Sheela K. M. ◽  
Shanta Sadashivan ◽  
Keerthi C. P.
Keyword(s):  
Case Report ◽  
Clinical Diagnosis ◽  
Fallopian Tube ◽  
Histopathological Examination ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Papillary Adenocarcinoma ◽  
Primary Carcinoma ◽  
Fibroid Uterus ◽  
Intramural Fibroids

Primary carcinoma of fallopian tube is rare and accounts for only 0.7-1.5% of all gynecological malignancies. Majority of the patients are postmenopausal with mean age of 61 years. Study present a case of 48-year-old lady, who underwent total abdominal hysterectomy with bilateral salpingo oophorectomy for a clinical diagnosis of fibroid uterus. Histopathological examination revealed, in addition to intramural fibroids, bilateral serous papillary adenocarcinoma of fallopian tube. We present this case due to its rarity.

scholarly journals Non Puerperal Uterine Inversion Secondary to Submucosal Fibroid: A Case Report

2021 ◽  
Author(s):  
Nilaj Bagde ◽  
Sefali Shinde ◽  
Vinita Singh ◽  
Rahul Satarkar ◽  
Habung Yarang
Keyword(s):  
Exploratory Laparotomy ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Packed Red Blood Cells ◽  
Submucous Myoma ◽  
Uterine Inversion ◽  
Satisfactory Condition ◽  
Fibroid Polyp ◽  
Uncommon Condition ◽  
Vaginal Canal

Non Puerperal Uterine Inversion (NPUI) is a very uncommon condition. The incidence of puerparal uterine inversion make an estimate of 1/30,000 deliveries and NPUI approximately 17% of all uterine inversion. The most common cause which leads to uterine inversion is a submucous myoma attached to the fundus but diagnosis can be difficult to make. The management of uterine inversion is always challenging for a surgeon. In the present case a 38-year-old woman, presented with significant anaemia because of menorrhagia. She used to feel mass occasionally into the vaginal canal which never comes out of the introitus, the mass was elucidated as a fibroid polyp. On investigation, her haemoglobin was 6.6 gm%, with continous bleeding per vaginum, patient was transfused with three units packed red blood cells and planned for surgery. A diagnosis of incomplete uterine inversion secondary to a submucous fibroid was made at exploratory laparotomy. Total abdominal hysterectomy, right salpingectomy with left salpingo-oophorectomy was performed. The patient was discharged under satisfactory condition.

Chronic Inversion of Uterus Following Spontaneous Abortion: A Case Report

2020 ◽  
Vol 3 (2) ◽  
pp. 41-43
Author(s):  
Tara Manandhar ◽  
Deepa Shah ◽  
Pappu Rijal
Keyword(s):  
Coming Out ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Trimester Abortion ◽  
Uterine Inversion ◽  
Pain Abdomen ◽  
Threatening Condition ◽  
Lower Pain ◽  
Life Threatening ◽  
History Of

Uterine inversion is a rare entity but poses a serious threat if not diagnosed and managed timely. Here we present a case of chronic uterine inversion in a 30-year-old lady who presented in emergency with a mass coming out per vagina, blood mixed vaginal discharge, and lower pain abdomen for the last 15 days. She underwent laparotomy and was found to have uterine inversion. The patient was attempted for repositioning of uterus with the Huntington’s approach, but it was unsuccessful, hence Haultain’s operation was done with a total abdominal hysterectomy and bilateral salpingectomy with right-sided ovarian cystectomy for a dermoid cyst. Our case emphasizes the importance of keeping chronic uterine inversion as a differential diagnosis in women presenting with pain abdomen, mass, and bleeding per vagina, and with a recent history of second-trimester abortion. Timely recognition, especially in chronic inversion, will decrease the morbidity and mortality associated with this rare but life-threatening condition.

scholarly journals A case of non-pueperal chronic uterine inversion managed successfully

2020 ◽  
Vol 10 (1) ◽  
pp. 419
Author(s):  
Michelle Fonseca ◽  
Ashwini Desai ◽  
Deepali Kapote ◽  
Swati Gawai ◽  
Anam Syed
Keyword(s):  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Clinical Findings ◽  
Rare Occurrence ◽  
Uterine Inversion ◽  
Fibroid Polyp ◽  
Inside Out ◽  
Multiparous Female ◽  
Uterine Fundus

Uterine inversion is prolapse of the uterine fundus and corpus turned inside out towards or through the cervix. The non-puerperal type of uterine inversion is a quite rare occurrence and it accounts for only 17% of all uterine inversion cases. We present a case of 45 year old multiparous female who presented to us with polymenorrhagia with fibroid polyp. Ultrasonography confirmed the clinical findings however Intraoperatively examination under anaesthesia revealed uterine inversion. On table we proceeded with Haultains method of uterine reposition followed by total abdominal hysterectomy. Patient recovered well and thus case was successfully managed.

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