International Journal of Gynecology and Obstetrics (2005) 89, 61 62

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Idiopathic chronic uterine inversion in a nulligravida

S.E. Adaji*, A.J. Randawa, O.S. Shittu
Obstetric and Gynaecology Department, ABU Teaching Hospital, Zaria, Nigeria
Received 24 November 2004; accepted 10 January 2005

KEYWORDS
Nulligravida; Uterine inversion; Idiopathic

A 25-year-old nulligravida presented at this Gynaecology clinic with post coital and intermenstrual bleeding with brownish vaginal discharge dating 8 months. She attained menarche at 18 years of age and since then had normal menstruation until onset of complaints. She had moderate pallor with normal cardiopulmonary status and her abdomen was normal. There was a reddish, firm, polypoid, friable and tender mass measuring 64 cm in the vagina which appeared continuous with the cervix but the uterus was not bimanually ballotable. An impression of cervical polyp with anaemia was made to exclude a chronically inverted uterus. She was transfused and had examination under anaesthesia (EUA) and the findings were consistent
* Corresponding author. Tel.: +234 8037 862 894. E-mail address: unyiwa@yahoo.com (S.E. Adaji).

with idiopathic chronic non-puerperal uterine inversion. The uterus was repositioned using the Haultains operation as described below. Her post-operative recovery was satisfactory and she resumed normal menstruation 4 weeks later. Chronic non-puerperal uterine inversions are very rare and almost all reported cases have been associated with benign or malignant tumors of the corpus uteri, commonly submucous leiomyoma and endometrial polyps, uterine sarcomas, cervical and endometrial cancers as well as senility especially in cases where high cervical amputations had been previously performed [1]. Inversion is considered idiopathic when no cause is found, as was the case here. Such is extremely rare accounting for less than 3% of all reported cases. Selkin and Aronson in 1941 described such a case in a 38-year-old parous woman and MacKinlay reported one in 1958 in a 79year-old postmenopausal woman [2]. Patients presentations mimick those of female genital tract tumors like cervical polyps, submucous fibroids/ endometrial polyps undergoing extrusion and cervical malignancies. Useful hints for distinction include the fact that the inverted uterus bleeds easily to touch and the intrauterine openings of the

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62 fallopian tubes may be identifiable on its endometrial surface. Failure to feel the cervix and probe the endocervical canal/endometrial cavity coupled with an absent corpus uteri on bimanual rectal examination is also very useful in diagnosis. In this patient, Haultains procedure was used to reposition the uterus. This involved incising the constricting cervical ring posteriorly and repositioning the uterus by traction at its fundus. It is the most popular technique for correcting a chronically inverted uterus and suitable for this patient who was nulligravid and desirous of conception [3]. Studies show that after operative correction of inversion of this sort, normal pregnancy and uncomplicated delivery is attainable [4]. This case attests to the fact that chronic uterine inversion could occur without the usual predispos-

S.E. Adaji et al. ing factors and vigilance is necessary to detect these unusual presentations.

References
[1] Mwinyoglee J, Simelela N, Marivate M. Non-puerperal uterine inversions. A two case report and review of the literature. Cent Afr J Med 1997 Sep.;43(9):28 71. [2] Gowrie V. Uterine inversion and corpus malignancies: a historical review. Obstet Gynecol Surv 2000 Nov.;55(11): 703 7. [3] Emanuel L, Maurice C. Surgical management of non-puerperal inversion of the uterus. Obst Gynaecol 1968 Sep.; 32(3):376 81. [4] Sinha G, Sinhan A. Fertility and reproduction following inversion of the uterus. J Indian Med Assoc 1993 Jun.; 91(6):149 50.