Non-puerperal uterine inversion secondary to prolapsed uterine fibroid in a 21-year-old lady with favorable outcome: a case report
Nzometia C. Yimlefack, Forchap N. Milton, Ashu J. Nchung, Wamba A. Gabrielle, Sow Aissatou, Nana D. TheophilleIntroduction and importance:
Non-puerperal uterine inversion (NPUI) is exceedingly rare in younger women. In a resource-poor setting, it poses both diagnostic and therapeutic challenges.
Case presentation:
We present a 21-year-old G0P0, sexually active woman who presented with a 1-week history of vaginal bleeding complicated by hypovolemic shock in the context of a prolapsed 8 cm myoma beyond the introitus. Her hemoglobin level on admission was 6 g/dL. Following an initial transfusion of 2 units of whole blood, successful twisting and untwisting of the protruding myoma on its pedicle (vaginal myomectomy/bistournage) was performed. Following tumor excision (vaginal myomectomy), repeat pelvic examination revealed a persistent mass protruding through the dilated cervical os, and an inability to define the borders of the cervix. Attempts at manual transvaginal reduction of the inverted uterus failed and triggered brisk vaginal hemorrhage. Failure to reposition the uterine fundus to its normal anatomical position led to a laparotomy with uterine repositioning. A horizontal incision on the anterior uterine wall was made, with successful repositioning of the uterine fundus. Her postoperative recovery was uneventful, and she was dischared on the fifth day and was followed up on an outpatient basis, with return of normal menstrual flow a month later.
Clinical discussion:
This case highlights the unusually early onset of symptomatic fibroids in young Black women presenting with NPUI in resource-limited settings where immediate diagnostic facilities are unavailable. An anterior transverse uterine incision, performed to reposition the uterine fundus in the context of NPUI, successfully repositioned the uterus.
Conclusion:
The management of NPUI due to fibroids in young women may be associated with an increased chance of surgical intervention. In a resource-poor setting, the bistournage technique may upstage NPUI, as the diagnosis is made after the resection of the prolapsed cervical fibroid. Our case presents a very rare case of a fibroid in a 21-year-old and demonstrates that an anterior transverse uterine incision of approximately 2 cm also gives the surgeon access to reposition the fundus of the uterus.