A rare case of acute non puerperal complete uterine inversion in nulliparous virgin female


  • Saurabh V. Bhangale Department of Obstetrics and Gynecology, Jagjivan Ram Hospital, Mumbai Central, Mumbai, Maharashtra, India
  • Ashok Kumar Department of Obstetrics and Gynecology, Jagjivan Ram Hospital, Mumbai Central, Mumbai, Maharashtra, India
  • Mamta Sharma Department of Obstetrics and Gynecology, Jagjivan Ram Hospital, Mumbai Central, Mumbai, Maharashtra, India
  • Naina Arora Department of Obstetrics and Gynecology, Jagjivan Ram Hospital, Mumbai Central, Mumbai, Maharashtra, India




Non puerperal uterine inversion, Nulliparous, Virgin, Acute complete uterine inversion


Non-puerperal uterine inversion (NPUI) is extremely rare and accounts for 17% of all uterine inversion cases. A few more than 150 cases have been reported amongst which 10-15 have been reported in nulliparous females and 3-4 have been reported in virgin females from 1914 till date. A 40 years unmarried nulliparous female denying sexual activity presented to our hospital with acute non puerperal complete uterine inversion with something coming out per vaginum of sudden onset while straining at defecation, lower abdominal pain and minimal bleeding per vaginum with history of uterine fibroid and chronic constipation. Diagnosis was confirmed with ultrasonography and examination under anaesthesia after written informed valid consent. After detailed counselling and obtaining written informed valid consent, the patient underwent exploration with a combined abdominal-vaginal approach. Following vaginal myomectomy, the uterus was repositioned using Haultain procedure after a failed attempt of Huntington procedure. Total abdominal hysterectomy with bilateral salpingectomy with vaginal vault suspension was done sparing bilateral ovaries. Diagnosis requires a high index of suspicion and their management is a challenge to gynaecologists due to its rare occurrence, distorted pelvic anatomy and associated pelvic organ injuries during surgery. Good anatomical and clinical knowledge along with surgical skills is of utmost importance for successful outcomes.


Katke RD. Extremely rare case report of chronic inversion of uterus with submucous fundal fibroid with dragging of bladder wall and ureters along with: a case report and review of literature. Int J Reprod Contracept Obstet Gynecol. 2014;3:479-82.

Shambhavi P. Non-puerperal uterine inversion with submucous fibroid - A rare case report. Indian J Case Rep. 2018;4(1):73-5.

Fofie CO. Baffoenon-puerperal uterine inversion: a case report. Ghana Med J. 2010;44(2):79-81.

Pinder LF, Ouma KO, Nelson BD. Non-Puerperal Uterine Inversion in a Young Woman: A Case Report, Brief Surgical Review, and Clinical Insights. Clin Med Rev Case Rep. 2016;3(8):122.

De Vries P. Non-puerperal uterine inversion due to submucous myoma in a young woman: a case report. J Med Case Rep. 2010;4:21.

Younas K, Chisholme B, Neelankavil J, Kevelighan E. A Rare Case of Nonpuerperal Uterine Inversion Managed by a Combined Laparoscopic and Vaginal Approach. J South Asian Federation Obstetr Gynaecol. 2019;11(1):81-3.

Herath RP, Patabendige M, Rashid M, Wijesinghe PS. Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know? Hindawi Obstetr Gynecol Int. 2020;8625186;12.

Alsahabi J, Alsomairi A, Elmuzaini F. Non-puerperal uterine inversion due to submucosal fibroid in a nulliparous woman: A case report. Int J Case Rep Images. 2019;10:101008Z01JA2019.

Nahid E. Non-puerperal uterine inversion in a virgin woman. Iranian J Reproductive Med. 2007;5:135-6.

Hu CF, Lin H. Ultrasound diagnosis of complete uterine inversion in a nulliparous woman. Acta Obstetricia et Gynecologica Scandinavica. 2012;91(3):379-81.

Zohav E, Anteby EY, Grin L. U-turn of uterine arteries: a novel sign pathognomonic of uterine inversion. J Ultrasound. 2018;23(1):77-9.

Moulding F, Hawnaur JM. MRI of non-puerperal uterine inversion due to endometrial carcinoma. Clin Radiol. 2004;59(6):534-7.

Salomon CG, Patel SG. Computed tomography of chronic nonpuerperal uterine inversion. J Computer Assisted Tomography. 1990;14(6):1024-6.

Lewin JS, Bryan PJ. MR imaging of uterine inversion. J Comput Assist Tomogr. 1989;13:357-9.

Omololu OM, Rabiu KA, Quadri MA, Oyedeko MO, Fatogun YM. Non puerperal uterine inversion due to submucous fibroid: a case report. Nig Postgraduate Med J. 2011;18(2):158-60.

Umeononihu OS, Adinma JI, Obiechina NJ, Eleje GU, Udegbunam OI, Mbachu II. Uterine leiomyoma associated non-puerperal uterine inversion misdiagnosed as advanced cervical cancer: a case report. Int J Surg Case Rep. 2013;4(11):1000-3.

Leconte I, Thierry C, Bongiorno A, Luyckx M, Fellah L. Non-puerperal uterine inversion. J Belgian Society Radiol. 2016;100(1):47.

Irani S, Jeyapalan K, McHugo J, Jordan JA. Chronic non-puerperal inversion of the uterus. J Obstetr Gynaecol. 1998;18(2):202-3.

Zhang Y, Hua KQ. Patients’ age, myoma size, myoma location, and interval between myomectomy and pregnancy may influence the pregnancy rate and live birth rate after myomectomy. J Laparoendoscopic Adv Surgical Techn. 2014;24(2):95-9.

Mwinyoglee J, Simelela N, Marivate M. Non-puerperal uterine inversions: a two case report and review of literature. Central Afri J Med. 1997;43(9):268-71.

Mayadeo NM, Tank PD. Non-puerperal incomplete lateral uterine inversion with submucous leiomyoma: a case report. J Obstetr Gynaecol Res. 2003;29(4):243-5.

Zhang X, Sun L, Chen X, Hua K. Uterus preserving reposition of non-puerperal uterine inversion under laparoscope: a case report and literature review. Gynecol Obstetr Investigation. 2015;79(3):206-9.






Case Reports