Chronic total uterine inversion in an adolescent

Key Clinical Message

Uterine inversion is rarely seen in adolescents in western countries. But it might be seen in teenagers and adolescents due to poor conditions and early pregnancies in Africa. And early troubleshooting chronic uterine inversion represents an early resolution of the problem and allows planning pregnancy without complications.

A 15-year-old woman complaining of infertility for 1 year was admitted to Gynecology outpatient clinic. History revealed that she gave birth in poor health conditions in the rural area of Nyala 18 months ago. Vaginal inspection revealed a bleeding, soft and fragile mass filling the whole vagina (Fig. 1A). A hard and tight cervical ring was palpated behind this mass. Transvaginal ultrasonography revealed inverted uterus and normal ovaries (Fig. 1B). We tried to loosen the cervical contraction ring and push the uterus to its normal position under general anesthesia. This procedure failed to succeed and we tried a second procedure. We made a Pfannenstiel incision to assess the intrapelvic anatomy. Uterus could not be observed intraoperatively, but ovaries stuck together and made “kissing ovaries” appearance. (Fig. 1C). Houltain's technique was used to correct the uterine anatomy 1,2. Physical examination revealed that cervical and uterine anatomy were settled in the normal position, when she applied to the outpatient for follow-up after 15 days (Fig. 1D). Hereby, we aimed to report an adolescent chronic uterine inversion case without any complaints except infertility.

Figure 1.

(A) Speculum examination showing a bleeding, fragile mass. (B) Ultrasonographic image of an inverted uterus. (C) Intraoperative “kissing ovaries” appearance. (D) Normal cervical appearance after operation.

Conflict of Interest

None declared.