Perforated uterus
Diagnosis certain
Updates to Case Attributes
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was changed:
This young female patient had had a recent surgical termination of pregnancy performed elsewhere and had presented to our institution in extremis.
Uterine perforation is fortunately rare and may be either iatrogenic or a spontaneous event. Iatrogenic causes include virtually any O&G procedure including dilatation and curettage (D&C), hysteroscopy, IUCD insertion, etc. Spontaneous perforation is rarer and aetiologies include gestational trophoblastic disease, pyometra, placenta accreta or even degenerating fibroid.
Uterine perforation following surgical termination of pregnancy is a rare event, usually in women that have had previous gynaecological surgery 1. More rarely still is the passage of fetal parts into the abdominal cavity, with little in the published literature 2,3. In some cases of iatrogenic uterine perforation the perforation goes unrecognised during the initial procedure. D&C is considered a well-tolerated procedure with a low incidence of complications. Uterine perforation has been reported to occur in 0.07 to 1.2% cases 3.
-<p>This young female patient had had a recent surgical <a title="Termination of pregnancy (TOP)" href="/articles/termination-of-pregnancy-top">termination of pregnancy</a> performed elsewhere and had presented to our institution <em>in extremis</em>. </p><p><a title="Uterine perforation" href="/articles/uterine-perforation">Uterine perforation</a> is fortunately rare and may be either <a title="Iatrogenic" href="/articles/iatrogenic">iatrogenic</a> or a spontaneous event. Iatrogenic causes include virtually any O&G procedure including <a title="dilatation and curettage (D&C)" href="/articles/dilatation-and-curettage-d-c">dilatation and curettage (D&C)</a>, <a title="hysteroscopy" href="/articles/hysteroscopy">hysteroscopy</a>, <a title="IUCD" href="/articles/intrauterine-contraceptive-device-1">IUCD</a> insertion, etc. Spontaneous perforation is rarer and aetiologies include <a title="Gestational trophoblastic disease" href="/articles/gestational-trophoblastic-disease">gestational trophoblastic disease</a>, <a title="Pyometra" href="/articles/pyometrium">pyometra</a>, <a title="Placenta accreta" href="/articles/placenta-accreta">placenta accreta</a> or even <a title="Fibroid disease" href="/articles/uterine-leiomyoma">degenerating fibroid</a>.</p><p>Uterine perforation following surgical termination of pregnancy is a rare event, usually in women that have had previous gynaecological surgery <sup>1</sup>. More rarely still is the passage of fetal parts into the abdominal cavity, with little in the published literature <sup>2,3</sup>. In some cases of iatrogenic uterine perforation the perforation goes unrecognised during the initial procedure. D&C is considered a well-tolerated procedure with a low incidence of complications. Uterine perforation has been reported to occur in 0.07 to 1.2% cases <sup>3</sup>.</p>- +<p>This young female patient had had a recent surgical <a href="/articles/termination-of-pregnancy-top">termination of pregnancy</a> performed elsewhere and had presented to our institution <em><a title="In extremis" href="/articles/in-extremis-1">in extremis</a></em>. </p><p><a href="/articles/uterine-perforation">Uterine perforation</a> is fortunately rare and may be either <a href="/articles/iatrogenic-disease-1">iatrogenic</a> or a spontaneous event. Iatrogenic causes include virtually any O&G procedure including <a href="/articles/dilatation-and-curettage-d-c">dilatation and curettage (D&C)</a>, <a href="/articles/hysteroscopy">hysteroscopy</a>, <a href="/articles/intrauterine-contraceptive-device-1">IUCD</a> insertion, etc. Spontaneous perforation is rarer and aetiologies include <a href="/articles/gestational-trophoblastic-disease">gestational trophoblastic disease</a>, <a href="/articles/pyometrium">pyometra</a>, <a href="/articles/placenta-accreta">placenta accreta</a> or even <a href="/articles/uterine-leiomyoma">degenerating fibroid</a>.</p><p>Uterine perforation following surgical termination of pregnancy is a rare event, usually in women that have had previous gynaecological surgery <sup>1</sup>. More rarely still is the passage of fetal parts into the abdominal cavity, with little in the published literature <sup>2,3</sup>. In some cases of iatrogenic uterine perforation the perforation goes unrecognised during the initial procedure. D&C is considered a well-tolerated procedure with a low incidence of complications. Uterine perforation has been reported to occur in 0.07 to 1.2% cases <sup>3</sup>.</p>
References changed:
- 1. Pridmore B & Chambers D. Uterine Perforation During Surgical Abortion: A Review of Diagnosis, Management and Prevention. Aust N Z J Obstet Gynaecol. 1999;39(3):349-53. <a href="https://doi.org/10.1111/j.1479-828x.1999.tb03413.x">doi:10.1111/j.1479-828x.1999.tb03413.x</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10554950">Pubmed</a>
- 2. Bowerman R, Pennes D, Jongeward R. Sonographic Identification of an Unusual Complication of Midtrimester Pregnancy Termination: Unrecognized Intra-Abdominal Extrusion of Fetal Parts. J Clin Ultrasound. 1988;16(2):119-22. <a href="https://doi.org/10.1002/jcu.1870160210">doi:10.1002/jcu.1870160210</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/3130403">Pubmed</a>
- 3. Chauhan N, Gupta A, Soni P, Surya M, Mahajan S. Iatrogenic Uterine Perforation with Abdominal Extrusion of Fetal Parts: A Rare Radiological Diagnosis. J Radiol Case Rep. 2013;7(1):41-7. <a href="https://doi.org/10.3941/jrcr.v7i1.1332">doi:10.3941/jrcr.v7i1.1332</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23372874">Pubmed</a>
- 1. Pridmore BR, Chambers DG. Uterine perforation during surgical abortion: a review of diagnosis, management and prevention. (1999) The Australian & New Zealand journal of obstetrics & gynaecology. 39 (3): 349-53. <a href="https://doi.org/10.1111/j.1479-828x.1999.tb03413.x">doi:10.1111/j.1479-828x.1999.tb03413.x</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10554950">Pubmed</a> <span class="ref_v4"></span>
- 2. Bowerman RA, Pennes DR, Jongeward RH. Sonographic identification of an unusual complication of midtrimester pregnancy termination: unrecognized intra-abdominal extrusion of fetal parts. (1988) Journal of clinical ultrasound : JCU. 16 (2): 119-22. <a href="https://doi.org/10.1002/jcu.1870160210">doi:10.1002/jcu.1870160210</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/3130403">Pubmed</a> <span class="ref_v4"></span>
- 3. Chauhan NS, Gupta A, Soni PK, Surya M, Mahajan SR. Iatrogenic uterine perforation with abdominal extrusion of fetal parts: a rare radiological diagnosis. (2013) Journal of radiology case reports. 7 (1): 41-7. <a href="https://doi.org/10.3941/jrcr.v7i1.1332">doi:10.3941/jrcr.v7i1.1332</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23372874">Pubmed</a> <span class="ref_v4"></span>
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