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Total laparoscopic hysterectomy for non-puerperal uterine inversion: anatomical and operative considerations
AbstractThe diagnosis and management of non-puerperal uterine inversion can be challenging. The majority of case are caused by benign leiomyomas, but 15 % are related to a malignant mass. Published case reports can guide gynaecologists who encounter this rare condition and provide valuable insight in its management. We present a case of non-puerperal uterine inversion in a pre-menopausal woman treat-ed by total laparoscopic hysterectomy. We discuss the chal-lenges we encountered due to the distorted pelvic anatomy and conclusions drawn from a literature review. The article
is accompanied by relevant video material. A high level of suspicion is required for the diagnosis of non-puerperal uter-ine inversion. Morcellation techniques should be avoided due to the potential for malignancy. Where myomectomy is per-formed vaginally, the possibility of uterine rupture should be taken into account. Management by total laparoscopic hyster-ectomy has not been reported previously, but appears to be feasible. The technique should be meticulous and aim to iden-tify by dissection important structures.
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