Presentation
Post suction evacuation for termination of pregnancy. Persistent hypotension and severe pain
Patient Data
Large volume of high attenuation peritoneal fluid in keeping with hemoperitoneum is seen within the pelvis, along paracolic gutters, perihepatic and perisplenic spaces.
Abnormal bulky uterus with heterogenous density. An area of hypodensity which extends to the right anteroinferior surface of uterine body is suspicious of uterine perforation. Moderate volume of hyperdense clot around the uterus noted.
A 6.5 x 4.5cm well defined right adnexal cyst is likely a physiological right ovarian cyst. The left ovary appears unremarkable.
No intraperitoneal free gas. No significant abnormality of the unprepared bowel or remaining solid organs. Lungs bases are clear. No bony abnormality.
Summary: Appearances in keeping with uterine perforation with large volume hemoperitoneum.
Case Discussion
The patient was subsequently taken to theater where there was found to be dehiscence of the cesarean section scar. Uterine perforation is an important consideration when there has been hypotension following any gynecological surgical intervention.
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