Uterine Inversion Secondary to a Large Prolapsed Leiomyoma: Diagnostic and Management Challenges.

Uterine inversion is characterised by the collapse of the fundus into the uterine cavity. Non-puerperal uterine inversion is an extremely rare entity, with less than 200 reported cases thus far. In light of the non-specific presentation, its diagnosis is challenging. Furthermore, in case of malignancy suspicion associated with its presentation, the management should be guided by the recommendations of a central multidisciplinary team. Here, we present the case of a 47-year-old, para 1 woman presented in the emergency department with hypovolaemic shock secondary to menorrhagia as well as urinary retention. MRI scan revealed uterine enlargement and a heterogeneous mass protruding into the vagina. The findings were in keeping with a large prolapsed leiomyoma causing uterine inversion and acute bilateral hydronephrosis; yet, the possibility of uterine leiomyosarcoma could not be excluded. The patient underwent urgent total abdominal hysterectomy, bilateral salpingo-oophorectomy and omental biopsy to alleviate pressure. A 20-cm pelvic mass filling the vagina was found, which was reported to be a pedunculated uterine leiomyoma with no evidence of malignancy. Surgical management led to a positive outcome with no post-surgical complications.