Reproductive preservation in non-puerperal uterine inversion from adenomyoma: a case report

BACKGROUND: Non-puerperal uterine inversion (NPUI) occurs extremely rarely and is typically associated with uterine tumors, but cases of NPUI arising from polypoid adenomyoma are even less common. The non-specific presentation of NPUI often leads to delayed diagnosis, and existing fertility-preserving surgeries lack tailoring to polypoid adenomyoma's features. CASE PRESENTATION: A 32-year-old nulliparous Asian woman presented with heavy menstrual bleeding, a prolapsing vaginal mass, and severe anemia (Hemoglobin 32 g/L). Magnetic resonance imaging confirmed NPUI. Surgical management involved vaginal traction for precise lesion localization, Haultain's procedure for uterine repositioning, and layered suturing for repair. Histopathology identified a polypoid adenomyoma. Follow-up demonstrated resolution of symptoms and return to normal menstruation. CONCLUSION: This optimized surgical strategy provides replicable details and references for the fertility-preserving management of rare NPUI.