J Menopausal Med.  2016 Dec;22(3):184-187. 10.6118/jmm.2016.22.3.184.

Non-puerperal Uterine Inversion Presented with Hypovolemic Shock

• Song YJ
• Yang J
• Yun HS
• Lee SK
• Kim HG
• Lee DH
• Choi OH
• Na YJ

• KMID: 2378240
• DOI: http://doi.org/10.6118/jmm.2016.22.3.184

Abstract

We report a non-puerperal uterine inversion with nulliparous women caused by huge pedunculated submucosal fibroid. Massive bleeding from protruding mass through vagina brought the heart to stop in 42-year-old nulliparous woman. She became cardiopulmonary resuscitation survivor in emergency room and then underwent laparotomy which ended in successful myomectomy rather than hysterectomy considering her demand for future fertility. Meticulous and adequate fluid therapy and transfusion was also administered to recover from hypovolemic status. Pathologic report confirmed benign submucosal fibroid with degeneration, necrosis and abscess formation. Thus, clinician should be aware of uterine inversion when encountered with huge protruding vaginal mass and consider uterus-preserving management as surgical option when the future fertility is concerned.

Keyword

Fertility; Hypovolemia; Leiomyoma; Shock; Uterine inversion

MeSH Terms

Abscess
Adult
Cardiopulmonary Resuscitation
Emergency Service, Hospital
Female
Fertility
Fluid Therapy
Heart
Hemorrhage
Humans
Hypovolemia*
Hysterectomy
Laparotomy
Leiomyoma
Necrosis
Shock*
Survivors
Uterine Inversion*
Vagina

Figure

• 

  Fig. 1 Coronal plane on contrast enhanced computed tomography (CT) revealed the prolapsed mass in the uterus and retraction of fundus. (B) Axial plain on contrast enhanced CT revealed extravasation of contrast media (arrow), suggestive of active bleeding from the mass in the uterus.

• 

  Fig. 2 Pre- and intra-operative images. (A) Huge necrotic mass protruding from the vaginal introitus. (B) The uterus is fully inverted and the fundus is not visualized in intra-operative finding.

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  Fig. 3 Gross finding of resected intrauterine mass in size of 22 × 11.5 × 5.8 cm. Pathologic report revealed benign leiomyoma.

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