Chronic Inversion of Uterus with Submucous Fibroid Polyp Presenting in a Postmenopausal Woman

Abstract

Background: Chronic uterine inversion is an exceptionally rare gynecological condition, often misdiagnosed due to its nonspecific presentation. Unlike the acute puerperal form, chronic non-puerperal inversion typically results from underlying uterine pathology and poses unique diagnostic and surgical challenges.
Case Presentation: We report the case of a 64-year-old postmenopausal woman presenting with chronic pelvic discomfort, vaginal bulging, and abnormal bleeding. Physical examination revealed a large vaginal mass with associated polypoid tissue. Ultrasound imaging confirmed uterine inversion, characterized by the typical “bowl-shaped” uterine contour. Surgical management was undertaken via an abdominal approach. Intraoperative findings revealed complete uterine inversion with fundal involvement of both round ligaments and adnexa. A Haultain-like approach was employed to restore anatomy, followed by hysterectomy due to the patient’s age and uterine pathology. Histopathology revealed a submucosal fundal fibroid polyp with chronic endometritis. The patient had an uneventful recovery and remained symptom-free at six weeks postoperatively.
Conclusion: This case underscores the importance of considering chronic uterine inversion in the differential diagnosis of pelvic organ prolapse, particularly in postmenopausal women with a history of unmonitored vaginal deliveries. Prompt diagnosis via imaging and tailored surgical intervention are critical for optimal outcomes. Hysterectomy remains a definitive treatment in postmenopausal cases with underlying uterine pathology.