Chronic Non-Puerperal uterine inversion

INTRODUCTION. Inversion of the nonpuerperal uterus is rare. A high index of suspicion is required to make a prompt diagnosis. We describe here a 48-year old woman who was diagnosed with nonpuerperal uterine inversion clinically and ultrasonagraphically and successfully underwent vaginal hysterectomy in the Institute of Obstetrics and Gynecology, Egmore, Chennai. CASE PRESENTATION A 48 year-old perimenopausal woman presented to our emergency center with complaints of a huge mass protruding from her vagina. At the time of laparoscopy an inverted uterus with a dimple containing bilateral round ligaments, infundibulopelvic ligaments and bladder was observed.She subsequently underwent vaginal hysterectomy and bilateral salpingo-oophorectomy. Pathologic examination revealed a necrotic submucous fundal fibroid. CONCLUSION Chronic nonpuerperal inversion of the uterus is rare. Most of this condition is associated with either benign or malignant tumor arising from the uterine fundus such as submucous leiomyoma, sarcoma and endometrial carcinoma. Cases of complete and total uterine inversion are usually accompanied by constriction of the external cervical os that produce vascular stasis and in neglected cases, gangrene of the inverted uterus will occur.Infection should be suspected and appropriate broad spectrum antibiotics begun while planning surgery.