Total uterine inversion secondary to a large necrotic submucous fibroid managed by Haultain’s procedure and abdominal hysterectomy: a case report

Abstract

Abstract Background Non-puerperal uterine inversion (NPUI) is a rare but potentially life-threatening gynaecological emergency, most commonly associated with submucous leiomyomas. Chronic inversion complicated by necrosis and sepsis presents significant diagnostic and therapeutic challenges, particularly in resource-limited settings where delayed presentation is common. Case presentation We report a 49-year-old para 5 woman who presented with a prolonged history of heavy menstrual bleeding, offensive vaginal discharge, and a progressively protruding foul-smelling vaginal mass, which became irreducible three days prior to presentation. Clinical examination revealed a large necrotic mass protruding through the introitus with absence of the uterine fundus abdominally, consistent with complete uterine inversion. Transabdominal ultrasonography demonstrated an empty uterine cavity. Following initial resuscitation and stabilization for severe anaemia and sepsis, the patient underwent a combined surgical approach. The necrotic submucous leiomyoma was excised vaginally with adequate haemostasis, followed by abdominal reduction of the inverted uterus using Haultain’s procedure. Definitive management with total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. Histopathology confirmed necrotic submucous leiomyoma. The postoperative recovery was uneventful. Conclusion This case highlights a rare presentation of septic chronic NPUI and underscores the importance of a high index of suspicion in women presenting with prolapsed necrotic vaginal masses. A combined vaginal and abdominal surgical approach, preceded by adequate resuscitation, can achieve favourable outcomes. Definitive hysterectomy remains an appropriate treatment option in selected patients, particularly in the presence of infection and completed childbearing.