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Uterine inversionFrom: Steve (Steve@dhngwe2.db.healthlink.org.za)Tue Oct 19 00:45:10 1999
Today I saw something that I have never seen before. A forty year old parous woman with only one previous pregnancy was admitted with a two week history of a steadily increasing protrusion from the vagina. The resident diagnosed a prolapsed fibroid and came to ask what we were to do with her. His description of a non haemorrhagic mass outside the vagina did not fit with the cases of prolapsed fibroid I have seen previously so I examined the patient carefully and discovered a complete uterine inversion. At the apex of the inversion is a 4 -5 cm submucous fibroid, not pedunculated, and this is clearly the cause of the inversion. The exposed endometrial surface of the uterus is pale pink, non haemorrhagic and only slight indication of infection with a little pus like mucus. The patient was sweating and grunting with respiratory distress and also has a basal pneumonia. She has not yet given us permission to operate, which we need to delay while her chest is treated. I propose to carry out a procedure along the lines of something described by Kustner back in the 1870's which involves opening into the Pouch of Douglas and incising the posterior cervix, correcting the inversion and then repairing through the posterior fornix incision. The fundal fibroid will be removed first. Anybody else seen this and if so what did you do?
-- Steve Raymond Head of O & G Empangeni Hospital SOUTH AFRICA
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