Isolated Mesenteric Injury causing Ileal Devascularisation with Uterine Perforation following Termination of Pregnancy; A Case Report and Literature Review

Abstract

Surgical abortion is one of the leading causes of maternal mortality, constituting up to 20% of maternal deaths. Uterine perforation is a rare complication, accounting for4% of all the abortion related complications. Intestinal injury with uterine perforation following termination of pregnancy is even rare and is a potentially fatal complication with mortality of up to 10%. A 27-year-old G3P2L2 woman with 12 weeks of gestation referred to our hospital in hemorrhagic shock with a suspicion of uterine perforation following dilatation and curettage for termination of pregnancy. Patient underwent emergency laparotomy. She was found to have uterine perforation with mesenteric and ileal injuries intraoperatively. Perforation closure with ileoileal resection and anastomosis was done. Postoperatively the patient recovered completely. Prompt reporting/recognition of uterine perforation, preoperative resuscitation and early intervention are the most important steps in the management of patients with intestinal injury. Trauma surgeon should never hesitate or delay in considering an Emergency Laparotomy/laparoscopy in cases of suspected intestinal injury with uterine perforation. Emergency exploration decreases the morbidity and mortality to a great extent in patients with intestinal injury.

Keywords: Maternal mortality; Mesenteric injury; Termination of pregnancy; Unsafe abortion; Uterine perforation.

Fig. 1

Intraoperative image of the patient during laparotomy demonstrating mesenteric tear with ileal devascularisation (A); Uterine perforation at the fundus (B)

Fig. 2

Intraoperative image demonstrating the products of conception removed from uterus (A); the intraoperative view of the ileo-ileal end to end anastomosis (B)