Inversion of uterus with sub mucus fundal fibroid with secondary infection: a rare case report

Abstract

Uterine inversion is a rare gynecological condition where the uterus turns inside out, typically starting with the fundus descending into the uterine cavity and potentially progressing to complete inversion with vaginal prolapse. It is classified as complete or partial based on the extent of inversion. While most cases (85.8%) are acute and associated with childbirth, non-puerperal uterine inversion—occurring outside the obstetric context—accounts for only 16.35% of cases and is seldom encountered in clinical practice. Non-puerperal inversions are usually linked to uterine pathology and affect women in their reproductive years. The most common cause is the prolapse or extrusion of submucosal fibroids, particularly those located at the fundus, responsible for 80–85% of cases. Less common causes include endometrial polyps, neoplasms, and increased intra-abdominal pressure. Diagnosis of non-puerperal uterine inversion before surgery is difficult and requires a high index of suspicion. Management is exclusively surgical, with the choice of approach based on the patient’s fertility preferences. Uterus-preserving surgeries are preferred when future fertility is desired. Surgical techniques include abdominal approaches (Huntington and Haultain procedures) and vaginal approaches (Kustner and Spinelli procedures). Although abdominal hysterectomy is commonly performed, vaginal hysterectomy can be safe and effective with proper technique. Complications such as superinfection, ulceration, and necrosis of the prolapsed mass are possible and should be managed promptly with broad-spectrum antibiotics and appropriate wound care. Successful outcomes depend on early recognition, accurate diagnosis, and skilled surgical intervention tailored to the individual patient.