Various degrees of inversion are met with. Rarely inversion of one horn of the uterus is seen. In the case of fibroid polyp there may be a slight depression of part of the uterine wall, resulting from local atrophy and traction. In other cases inversion of the fundus as far as the internal os exists. The most usual condition is one of complete inversion, in which the body of the uterus protrudes from the external os into the vagina ([Fig. 138]). The cervix may or may not be inverted. Sometimes the inversion is complicated by vaginal prolapse—or, rather, by inversion of the vagina—so that the whole genital tract becomes turned inside out and protrudes from the vulva. The exposed endometrium becomes congested and bleeds easily. Ulceration or gangrene may result.
Fig. 138.—Complete inversion of the uterus.
If the inversion is extensive, the Fallopian tubes and the ovaries are drawn in the cup formed on the upper aspect of the uterus. Intestines or omentum may also lie in this cup. In cases of long standing the rim of the cup formed by the muscular cervix becomes very much contracted, and adhesions may take place between the peritoneal surfaces. These complications offer great, sometimes insurmountable, difficulty to reduction in old cases.
Inversion of the uterus is not a common disease. It is very rarely seen at the present day.
By far the most frequent form is that which follows labor; it is much less often caused by fibroid polyp. It seems especially likely to occur in sarcoma of the uterus.
Fig. 139.—Inversion of the uterus (Jeançons): a, mons veneris; c, c, nymphæ; d, clitoris; e, external meatus; g, anterior lip of cervix; h, h, the internal surface of the uterus.
The symptoms of chronic inversion are hemorrhage, discharge, backache, bearing-down pains in the pelvis, vesical disturbance, very pronounced anemia, and general physical weakness. Menstruation is very much increased in amount, and intermenstrual bleeding may occur after standing or on any physical effort.
Inversion of the uterus very rarely exists without causing serious symptoms. The majority of unrelieved cases end fatally from anemia, septicemia, or peritonitis. A few cases of spontaneous reduction and cure have been recorded.