Technique of abdominal hysterectomy for non-puerperal uterine inversion

A 52-year-old postmenopausal woman presented with lower abdominal pain, bleeding per-vaginum and a mass protruding per-vaginum of 1-week duration. A clinical diagnosis of non-puerperal uterine inversion due to fundal leiomyoma was made. Non-puerperal uterine inversion is a rare clinical condition and usually follows a benign or malignant mass attached to the fundus of uterus. Surgical procedures described in the literature use different techniques to first reposition the uterus followed by hysterectomy. However, repositioning the uterus is not always successful. Surgery for inverted uterus is technically difficult due to close proximity of the ureters to the ovarian and uterine vessels due to traction on the vascular pedicles, difficulty in repositioning the uterus and constraints of mobilising the bladder down due to the inverted uterus. This paper illustrates the salient steps of surgery to safely accomplish abdominal hysterectomy without repositioning the uterus to treat this rare condition.