Non-puerperal uterine inversion with prolapsed pedunculated submucosal fibroid/polyp: a rare gynaecological emergency

Abstract

Non-puerperal uterine inversion (NPUI) is a rare and potentially life-threatening gynaecological emergency, most commonly caused by a submucosal fibroid or endometrial polyp exerting traction on the uterine fundus. We report a case of a 40-year-old postmenopausal woman (P3L3) presenting with severe anaemia (haemoglobin 1.8 g/dl), per vaginal bleeding, and a 10×6×4 cm mass prolapsing through the vaginal introitus. Ultrasonography and contrast-enhanced computed tomography (CT) confirmed grade IV NPUI with a prolapsed pedunculated submucosal fibroid/polyp. Following multidisciplinary preoperative optimisation including blood transfusion, cardiac evaluation, and local wound care, the patient underwent polypectomy followed by total abdominal hysterectomy with bilateral salpingo-oophorectomy. An incidental left adnexal cystic lesion was also excised. The postoperative course was uneventful and the patient was discharged in stable condition. This case highlights the importance of early diagnosis using multimodality imaging and adequate preoperative optimisation prior to definitive surgical management. This case underscores the importance of multimodality imaging for diagnosis and multidisciplinary preoperative optimisation before definitive surgical management of NPUI. Total abdominal hysterectomy with bilateral salpingo-oophorectomy is safe and curative in postmenopausal women when surgery is appropriately timed.