Unit of Urogynecology, Department of Obstetrics and Gynecology, Rabin Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2011 Mar;283 Suppl 1:111-4. doi: 10.1007/s00404-010-1792-7. Epub 2011 Jan 28.
Ultrasonographic diagnosis of very rare case of complete non-puerperal uterine inversion secondary to a large sub-mucous fibroid.
A 50-year-old woman was admitted with heavy vaginal bleeding. Detailed vaginal and abdominal ultrasound, using color Doppler flow, raised the suspicion of complete uterine inversion. The distal ends of the fallopian tubes and part of the ovaries were demonstrated adherent to the uterine fundus. Laparoscopy showed there was no uterus inside the abdomen because of complete uterine inversion. Only a dimple with a constriction ring was found at the site of the uterus. A sub-mucous 6 cm fibroid was attached to the fundus, and vaginal myomectomy was performed to reduce uterine size in order to restore the uterus to its abdominal position. However, the uterus was impacted and only cutting longitudinally the anterior and posterior fornices helped to restore the uterus and facilitate an abdominal hysterectomy. Histological examination of the uterus and fibroid following hysterectomy confirmed their benign nature.
Ultrasonographic diagnosis of complete uterine inversion is feasible. However, high index of suspicion is necessary.
超声诊断罕见的大型黏膜下肌瘤继发完全非产后子宫内翻。
一名 50 岁妇女因阴道大量出血而入院。详细的阴道和腹部超声检查，使用彩色多普勒血流，提示完全子宫内翻的可能性。输卵管末端和部分卵巢附着在子宫底部。腹腔镜检查显示由于完全子宫内翻，腹部内没有子宫。在子宫部位只发现了一个带有收缩环的小凹痕。一个 6 厘米的黏膜下肌瘤附着在子宫底部，进行了阴道子宫肌瘤切除术以减小子宫大小，以便将子宫恢复到腹部位置。然而，子宫受到影响，只有纵向切开前后穹窿才能帮助恢复子宫并便于进行腹部子宫切除术。子宫和肌瘤切除术后的组织学检查证实它们为良性。
超声诊断完全子宫内翻是可行的。然而，需要高度怀疑。
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