Hysteroscopy combined with laparoscopy in the diagnosis and treatment of omentum majus incarceration secondary to uterine perforation: A case report and literature review

Abstract

Cervical dilatation, uterine evacuation, and curettage (D&E&C) are common gynecological procedures for abortion, yet they carry risks of complications such as uterine perforation and intra-abdominal organ incarceration. Here, we report a rare case of a breastfeeding patient who had an embedded abdominal greater omentum in the anterior wall of the uterus and into the uterine cavity during D&E&C. We used combined hysteroscopic and laparoscopic treatment for this case and successfully removed the embedded greater omentum. Our experience underscores the importance of vigilant intraoperative monitoring and prompt management to prevent serious complications like infection and bowel injury. In conclusion, hysteroscopic and laparoscopic combination treatment can be a preferred approach to avoid serious adverse outcomes for uterus perforation patients who developed omentum majus incarceration.

Keywords: combined hysteroscopic and laparoscopic; complication; induced abortion; omentum incarceration; uterine perforation.

FIGURE 1

Ultrasound image shows the presence of a hyperechogenic structure in the anterior wall of the uterus (a, b).

FIGURE 2

Pelvic magnetic resonance imaging (MRI) showed that adipose tissue was embedded in the anterior wall of the uterus to the uterine cavity by axial T2‐weighted image (a), axial fat‐suppressed T1‐weighted image (b), and sagittal fat‐suppressed T2‐weighted image (c).

FIGURE 3

Hysteroscopy examination revealed a pale‐pink mass with intrauterine (a). Final hysteroscopic. view with the omentum completely released (b). Laparoscopy showed an incarcerated omentum into uterine cavity through the uterine perforation site on anterior uterine wall (c). Cut off the omentum incarcerated (d). After the suture of the anterior uterine wall defect (e).