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Papers of the Week

2023 Jan 16

Am J Case Rep


A 63-Year-Old Postmenopausal Woman with Uterine Inversion Associated with a Submucosal Geburt Fibroid Successfully Treated by Surgical Reversal Using the Spinelli Procedure.


BACKGROUND Reproductive health affects long-term quality of life, including in the elderly. Uterine inversion is common in postpartum women in developing countries and menopausal women are also at risk. CASE REPORT A 65-year-old menopausal woman had 3 children and a history of uterine tumors and curettage. She had received a different diagnosis – a cervical tumor – exactly 3 years ago. She was admitted to a referral hospital for lower abdominal pain, difficulty in defecating, and a mass in the genitals when straining, accompanied by blood clots. There was a 20×20 cm mass protruding from the vagina, and the uterine fundus of the uterus was not palpable. The patient was diagnosed with chronic uterine inversion due to submucous leiomyoma. Management requires the collaboration of multidisciplinary professionals in hospitals. These patients receive therapy to improve their general condition, transfusions, antibiotics, and a hysterectomy plan. The results of the Urogynecology Division showed that a 20×15 cm mass came out of the vagina, with a large necrotic area. The patient was first managed by Spinelli procedure to correct the uterine inversion, followed by an abdominal hysterectomy. Histopathology revealed the final diagnosis as a benign mesenchymal lesion, leiomyoma with myxoid degeneration. CONCLUSIONS Timely diagnosis and management by a multidisciplinary team can help reduce morbidity and mortality in patients with submucosal uterine leiomyoma leading to chronic uterine inversion.