Uterine inversion is a rare condition. Non puerperal origin is a much rarer one; only 303 cases have been reported in the literature from 1911 to 2018 [4]. It is more common in perimenopausal and menopausal women than in young women [4,5,13-15].

Non puerperal inversion is often chronic which differentiates it from puerperal uterine inversion which is often acute due to the fact that it leads to delivery hemorrhage and hemodynamic instability [1,3,4,18].

The resulting symptomatology is often chronic: minimal menometrorrhagia, pelvic pain with heaviness and urinary signs such as dysuria and pollakiuria.

2 types of uterine inversion classified in 4 stages: incomplete uterine inversion corresponding to stage 1 (simple depression of the uterine fundus without crossing the cervical os). complete uterine inversion corresponding to stages 2 (the uterine fundus crosses the cervical os but remains intravaginal), 3 (the uterine fundus exteriorized to the vulva) and 4 (training of the vaginal walls which take part in the reversion resulting in uterine and vaginal inversion [1-3,14,18].

Stages 3 and 4 are easy to diagnose if the condition is known.

Pelvic ultrasound and MRI are relevant diagnostic tools [1, 2, 3, 4]: uterine inversion is radiologically translated by a vertical central groove in the uterus in longitudinal section forming a Y-shaped aspect of the uterine cavity in incomplete uterine inversion and a U-shaped aspect in the complete form. The radiological assessment also allows the etiological diagnosis.

Submucosal uterine fibroids remain the most common cause of uterine inversion, however a malignant pathology may be the cause in both young women and women who are in

peri-menopause and menopause.

A literature review analyzed 303 cases of non-puerperal uterine inversion [4], finding malignant pathology in 15.6%, myomatous pathology was estimated at 69.5%, idiopathic uterine inversion was estimated at 8%, and other etiologies at 5%. Gumbo et al reported 3 cases of uterine sarcoma in young women under 45 years of age [15]. A case of endometrial cancer in a 28-year-old woman was reported by Ueda et al [15]. A case of uterine inversion secondary to an immature teratoma in an adolescent girl was reported by Sousa et al [17].

Hysterectomy is the most described treatment in the literature for non-puerperal uterine inversion regardless of the associated benign or malignant pathology: 170 cases reported from 1940 to 2017 [4]: 145 cases (86.8%) treated by hysterectomy of which 78.6% (114 cases) combined the 2 abdominal and vaginal techniques. The repositioning of the uterus was reported in only 13% of cases. This may be justified by the fact that non-puerperal uterine inversion is a pathology that is more frequent in the perimenopausal and menopausal periods. In our case, the patient requested a hysterectomy despite her young age because her parental project was complete.

However, in young women, apart from malignancy, conservation of the uterus by repositioning is the treatment of choice to preserve fertility [4, 5, 19, 20]. Several techniques have been described [18]; by the abdominal approach 2 techniques can be used; Huntington's technique and Haultain's technique. The most common trans-vaginal approach is the Spinelli technique.

The Huntington technique consists of a progressive repositioning of the uterus with the help of non-traumatic forceps placed one after the other in the round ligaments and the uterine fundus until complete disinvagination of the uterus.

The spinelli procedure consists of a vesico-uterine detachment, opening of the vesico-uterine cul de sac, complete anterior uterine incision from the inverted fundus to the cervix thus allowing disinvagination of the uterus, after suture of the hysterotomy the repositioning of the uterus in the abdominal cavity is done through the opening of the vesico-uterine cul de sac.

In the literature review, no study was found evaluating the effectiveness of these different techniques; this can be explained by the rarity of the condition, especially in young women.