Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
Journal website https://www.journalmc.org

Case Report

Volume 14, Number 1, January 2023, pages 7-12

Uterine Inversion Secondary to Endometrial Carcinoma

Figures

Figure 1.
Figure 1. Ultrasound image with white arrow pointing to poorly defined mass within endometrial cavity. Red arrow indicates area where uterine fundus should be but was not well seen.
Figure 2.
Figure 2. Ultrasound image with Doppler blood flow showing blood vessels extending from the uterine fundus and anterior wall of the uterus into the mass.
Figure 3.
Figure 3. Prolapsed mass at introitus.
Figure 4.
Figure 4. Image from diagnostic laparoscopy with arrow indicating site of uterine inversion with bilateral tubes and ovarian ligaments pulled in.
Figure 5.
Figure 5. Computed tomography scan image (axial section) with white arrow indicating heterogenous hypodensity within the endometrial cavity.
Figure 6.
Figure 6. Computer tomography scan image (sagittal section) with white arrow indicating heterogenous hypodensity within the endometrial cavity which possibly extends to the endocervical canal.

Tables

Table 1. Stages of Uterine Inversion
 
Stage 1Incomplete inversion with the uterine fundus remaining within the cavity
Stage 2Complete inversion of the uterine fundus through the fibromuscular ring of the cervix
Stage 3Total inversion with the fundus protruding through the vulva
Stage 4The vagina is also involved and inverted through the vulva along with the uterus

 

Table 2. Methods for Reduction of Uterine Inversion
 
MethodRouteDescription
Johnson’s maneuverConservative (vaginal)Manual reduction by placing a hand inside the vagina and pushing the fundus along the long axis of the vagina towards the umbilicus.
O’Sullivan’s methodConservative (vaginal)Infusing warm saline into the vagina, therefore creating a water seal with the operator’s hand and the vulva.
Ogueh and Ayida technique (modified O’Sullivan’s method)Conservative (vaginal)An intravenous fluid tubing is connected to the silicon cup used in vacuum deliveries after the cup is placed in the vagina, creating a water seal when fluid is infused.
Huntington’s methodSurgical (abdominal)Sequential clamping and upward traction on the round ligaments using Allis/Babcock clamps starting from approximately 2 cm deep in the cup formed by the inversion. If the round ligaments are unable to be identified, the myometrium may be clamped instead.
Haultain procedureSurgical (abdominal)Incising the posterior surface of the uterus to bisect the constriction ring. This may then allow the inversion to be reduced manually or via Huntington’s method.
Spinelli’s methodSurgical (vaginal)Transecting the cervix anteriorly to bisect the constriction ring. This will be followed by manual reduction.
Kustner’s methodSurgical (vaginal)Transecting the cervix posteriorly to bisect the constriction ring. This will be followed by manual reduction.