Presentation
Severe acute abdominal pain, vomiting and history of recent D&C procedure.
Patient Data
1st trimester fetal U/S done for fetal viability showing no cardiac pulsation of fetal pole at 8 weeks gestational age.
U/S guided D&C was done with ultrasound images showing removal of the echogenic intrauterine contents (retained products of conception) with no evidence of pelvic collection at time of procedure. Obscuration of the fundal border by gas is noted.
Urgent U/S done in ER room 3 days post D&C showing posterior poorly defined heterogeneous area of possible mixed hematoma along with Morrison pouch mild collection.
Case Discussion
A patient with a history of 5 times D&C due to unexplained recurrent miscarriage.
She underwent recent D&C for removal of retained products of conception and 3 days after procedure she came to the ER room complaining of severe pain and vomiting.
Urgent U/S showing pelvic suspected hematoma. So, after consultation of obstetrician and surgeon, they refer her to the OR for exploration.
Laparoscopic exploration done and discovered posterior uterine wall perforation with related hematoma, abdominopelvic collection and also bowel injury.
Bowel resection and anastomosis were done along with uterine repair.
Uterine perforation is a potential complication of all intrauterine procedures and may be associated with injury to surrounding blood vessels or viscera (bladder, bowel).
The risk of uterine perforation is increased by altering the strength of the myometrial wall due to recurrent D&C like in this case.
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