Uterus-sparing laparoscopic reversal of complete nonpuerperal uterine inversion: a rare case and challenging procedure.

OBJECTIVE

To present а rare case of complete uterine inversion in a nonpregnant young woman who was managed successfully laparoscopically.

DESIGN

Video article with intraoperative narration and key surgical highlights.

SUBJECTS: A 24-year-old patient with a history of laparotomic staging for a granulosa-cell ovarian tumor was admitted as an emergency to the gynecological oncology department of our hospital, with sudden onset of intractable uterine bleeding, caused by a necrotic, hemorrhagic mass, protruding from the vagina.

EXPOSURE: Transvaginal excision of the lesion was attempted under laparoscopic control. At laparoscopy, complete uterine inversion was found. Μaneuvers to correct the inversion were unsuccessful. Hemostatic sutures were placed, and the patient was referred to our unit for further management. Histopathology suggested uterine adenomyoma. The uterine inversion was successfully reversed with a combination of laparoscopic and vaginal maneuvers after vertical anterior and posterior uterine incisions to divide the cervical constriction ring. The uterine cavity was opened, previous sutures were removed, and the uterus was reconstructed with resuturing in two layers. A prophylactic cervical cerclage tape was placed laparoscopically.

MAIN OUTCOME MEASURES: Anatomical restoration of the uterus.

RESULTS

At the six-month follow-up, the patient reported irregular cycles, without menorrhagia, and had a fairly normal-shaped uterus.

CONCLUSION

Successful laparoscopic management of uterine inversion in nonpregnant patients with fertility preservation has been rarely reported. It represents a most challenging procedure when uterine preservation is at stake.