Conservative management for non-puerperal uterine inversion in nulliparous woman: a rare case report

Non-puerperal uterine inversion (NPUI) is a rare condition in which the uterus turns inside out caused by a non-puerperal or gynecological condition. Management for NPUI includes surgery, with several available methods. In this case, we present a case of NPUI with a conservative management employing an abdominal-vaginal approach.

A 40-year-old nulliparous woman came due to hemorrhagic shock caused by vaginal bleeding and protruding mass from the vagina. Transabdominal ultrasound revealed the absence of uterus in the abdomen. She was resuscitated with intravenous fluid and blood transfusions. We decided to perform a surgery with combined abdominal-vaginal approach. Vaginal myomectomy was followed by uterus repositioning using the Kustner technique with extended incision to the uterine corpus. Hysterorrhaphy was performed to preserve the uterus. There was no complication after surgery.

NPUI is a rare tumor-related condition that poses diagnostic and surgical challenges. Imaging aids early recognition, while surgery remains as the main treatment. This case highlights successful uterine preservation using a combined vaginal-abdominal approach with the Kustner method.

This is a rare condition with risks of injuries to the pelvic organs during surgery. Gynecologists face difficulties in diagnosing and treating it promptly. As surgery is the main management in this case, selecting the appropriate method is essential. Fertility preservation was achieved in this case with an abdominal-vaginal surgical approach.