Abstract

A 30-year-old woman presented to the emergency department with nonspecific abdominal pain 17 days after voluntary vacuum aspiration interruption of a first-trimester pregnancy. Physical examination and laboratory evaluation demonstrated mild diffuse abdominal tenderness without peritoneal signs and a mildly increased WBC count, respectively. When the patient's condition failed to improve she was admitted, and exploratory laparotomy was performed 5 days later. It revealed two uterine perforations, one of which contained incarcerated omentum with associated ischemic small bowel and complete small-bowel obstruction. Although uterine perforation with intraabdominal injury is a well-described complication of vacuum aspiration termination of pregnancy, most postabortion perforations go undetected. Delayed presentation of an acute complication is rarely observed.

PIP:

Presented is the case of a 30-year-old US woman who sustained uterine perforation during vacuum aspiration abortion that was not detected until over two weeks after the procedure. The patient presented on postabortion day 17 with severe upper abdominal pain accompanied by nausea and vomiting; she noted that symptoms began one day after the abortion. Initial laboratory tests, physical examinations, and radiographs were unremarkable. It was not until laparotomy was performed, 22 days after the abortion, that two 1-cm perforations of the body of the uterus were revealed. One perforation contained incarcerated herniated omentum, and a band attached to the omentum had strangulated a 5-cm segment of the extrauterine small bowel, producing obstruction. Only one other case of delayed recognition of significant acute abortion-related intra-abdominal injury has been reported in the literature. It is suspected that many asymptomatic uterine perforations remain undetected.