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一名年轻女性出现非产褥期子宫内翻,伪装成宫颈肿物,这是一例具有挑战性的病例。

A challenging case of non-puerperal uterine inversion masquerading as cervical mass in a young female.

作者信息

Yadav Krohit, Bansal Lukshay, Prasad Akhilandeswari

机构信息

Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India.

Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2025 Jul;311:114079. doi: 10.1016/j.ejogrb.2025.114079. Epub 2025 May 22.

DOI:10.1016/j.ejogrb.2025.114079
PMID:40424852
Abstract

Uterine inversion, also know as, uterine intussusception is defined as telescoping of fundus of the uterus through the uterine cavity, and is graded into four grades based in the inferior bowing of the fundus with respect to the cervical and/or vaginal introitus. It is a rare entity, with two distinct group, with respect to the inciting cause, puerperal and non-puerperal. Non-puerperal is rarer of the two and has an array of presentation, ranging from acute emergent life-threatening condition to a chronic pelvic mass with menstrual irregularities. Such diversified presentation along with non-specific findings on ultrasonography, causes a diagnostic dilemma. Magnetic resonance imaging (MRI) is the best imaging modality, not just to clinch the diagnosis, but also to access the possible cause of the inversion. Typical MRI findings include loss of normal convex fundal contour on sagittal images and target sign on axial images. Management is mostly hysterectomy, with conservative management reserved for young females with desire of future child bearing and underlying benign cause. In our case report we present a case with MRI findings of grade II uterine inversion and a fundal submucosal fibroid, who presented with chronic pelvic pain and irregular menses. The patient was conservatively managed.

摘要

子宫内翻,也称为子宫套叠,定义为子宫底部通过子宫腔套叠,根据子宫底部相对于宫颈和/或阴道口的向下弯曲程度分为四级。它是一种罕见的病症,就诱发原因而言,有产后和非产后两种不同类型。非产后型在这两种类型中更为罕见,其表现形式多样,从急性危及生命状况到伴有月经不调的慢性盆腔肿块不等。这种多样的表现以及超声检查结果不具特异性,导致诊断陷入困境。磁共振成像(MRI)是最佳的成像方式,不仅有助于确诊,还能找出内翻的可能原因。典型的MRI表现包括矢状位图像上正常凸形子宫底部轮廓消失以及轴位图像上的靶征。治疗方法大多是子宫切除术,对于有未来生育意愿且病因良性的年轻女性则采用保守治疗。在我们的病例报告中,我们呈现了一例MRI显示为II级子宫内翻且伴有子宫底部黏膜下肌瘤的病例,该患者表现为慢性盆腔疼痛和月经不规律。该患者接受了保守治疗。

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