Subacute uterine inversion following an induced abortion in a teenage girl: a case report
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CASE REPORT
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Subacute uterine inversion following an induced abortion in a teenage girl: a case report Asiphas Owaraganise* , Leevan Tibaijuka and Joseph Ngonzi
Abstract Background: Subacute uterine inversion is a very rare complication of mid-trimester termination of pregnancy that should be considered in a situation where unsafe abortion occurs. Case presentation: We present a case of subacute uterine inversion complicated by hypovolemic shock following an unsafe abortion in a 17-year-old nulliparous unmarried girl. She presented with a history of collapse, mass protruding per vagina that followed Valsalva, and persistent lower abdominal pain but not vaginal bleeding. This followed her second attempt to secretly induce an abortion at 18 weeks amenorrhea. On examination, she was agitated, severely pale, cold on palpation, with an axillary temperature of 35.8 °C, a tachycardia of 143 beats per minute and unrecordable low blood pressure. The abdomen was soft and non-tender with no palpable masses; the uterine fundus was absent at its expected periumbilical position and cupping was felt instead. A fleshy mass with gangrenous patches protruding in the introitus was palpated with no cervical lip felt around it. We made a clinical diagnosis of subacute uterine inversion complicated with hypovolemic shock and initiated urgent resuscitation with crystalloid and blood transfusion. Non-operative reversal of the inversion failed. Surgery was done to correct the inversion followed by total abdominal hysterectomy due to uterine gangrene. Conclusion: Our case highlights an unusual presentation of subacute uterine inversion following unsafe abortion. This case was managed successfully but resulted in significant and permanent morbidity. Keywords: Case report, Subacute, Uterine inversion, Unsafe abortion, Johnson’s manoeuvre, Hysterectomy
Background Subacute puerperal uterine inversion occurs when the uterine fundus collapses into the endometrial cavity between 24 h to 1 month postpartum [1]. It is a rare gynaecological emergency in practice and literature [2] but potentially fatal when not diagnosed and treated fast. Uterine inversion is an unpredictable obstetric emergency that should be considered when a woman in puerperium presents with postpartum bleeding, low blood pressure, abdominal pain and a mass in the vagina. Its * Correspondence: [email protected] Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
management involves anatomical repositioning of the uterus while preventing re-inversion, and treating haemorrhage while restoring the patient’s haemodynamic stability. Urgent resuscitation with crystalloids and blood transfusion improves patient outcomes [3, 4]. Reversing uterine inversion is achieved using non-operative or surgical means. Non-surgical options include manual replacement and hydrostatic reduction while surgical correction includes laparotomy plus Huntington’s procedure alone or combined with incision of the cervical constriction ring. The t
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