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Horikawa E, Abbe CR, Staley BE, Ailabouni L. A Diagnostic Conundrum - Small bowel obstruction from undiagnosed endometriosis following uterine perforation. Int J Surg Case Rep 2023; 110:108703. [PMID: 37634434 PMCID: PMC10509787 DOI: 10.1016/j.ijscr.2023.108703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Uterine perforation is a rare but recognized complication from dilation and curettage, a common therapeutic procedure for obstetric complications and emergencies. Limited cases exist on endometriosis occurring following rupture. Additionally, there are no reported cases of uterine rupture secondary to dilation and curettage leading to new onset endometriosis first presenting as a small bowel obstruction (SBO). PRESENTATION OF CASE A 42-year-old female with recurrent small bowel obstruction was found to have a stricture caused by endometriosis via diagnostic laparoscopy and pathology. Patient had a dilation and curettage for retained products of conception 11 years prior, complicated by uterine perforation. This patient never had a diagnosis of endometriosis prior to her SBO. Patient made an uneventful recovery after small bowel resection with resolving of SBO symptoms. DISCUSSION Our case highlights the possibility of endometriosis due to previous uterine rupture as a cause for SBO in an otherwise healthy, female patient of reproductive age. There is a continued need for appropriate documentation of surgical complications on patient charts as well as considering postoperative complications when other etiologies of SBO are less likely. CONCLUSION Endometriosis should be considered as a differential in reproductive aged women presenting with a small bowel obstruction, with an increased index of suspicion if the patient has had previous obstetric surgical procedures.
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Affiliation(s)
- Erina Horikawa
- Washington State University, Elson S. Floyd College of Medicine, 412 E Spokane Falls Blvd, Spokane, WA 99202, United States of America.
| | - Carmen R Abbe
- Washington State University, Elson S. Floyd College of Medicine, 412 E Spokane Falls Blvd, Spokane, WA 99202, United States of America.
| | - Brian E Staley
- Providence Kadlec Medical Center - General, Breast and Colorectal Surgery, 780 Swift Boulevard, Suite 101, Richland, WA 99352, United States of America.
| | - Luay Ailabouni
- Washington State University, Elson S. Floyd College of Medicine, 412 E Spokane Falls Blvd, Spokane, WA 99202, United States of America; Providence Kadlec Medical Center - General, Breast and Colorectal Surgery, 780 Swift Boulevard, Suite 101, Richland, WA 99352, United States of America.
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2
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Zorilă GL, Căpitănescu RG, Drăgușin RC, Istrate-Ofițeru AM, Bernad E, Dobie M, Bernad S, Craina M, Ceaușu I, Marinaş MC, Comănescu MC, Zorilă MV, Drocaș I, Berbecaru EIA, Iliescu DG. Uterine Perforation as a Complication of the Intrauterine Procedures Causing Omentum Incarceration: A Review. Diagnostics (Basel) 2023; 13:diagnostics13020331. [PMID: 36673141 PMCID: PMC9858542 DOI: 10.3390/diagnostics13020331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Omentum involvement resulting from uterine perforation is a rare complication following intrauterine procedures that might require immediate intervention due to severe ischemic consequences. This review examines the prevalence of this complication, risk factors, the mode and timing of diagnosis, the proper management and the outcome. METHODS A systematic literature search was conducted on PubMed, PubMed Central and Scopus using uterine perforation, D&C, abortion and omentum as keywords. The exclusion criteria included the presence of the uterus or placenta's malignancy and uterine perforation following delivery or caused by an intrauterine device. RESULTS The review included 11 articles from 133 screened papers. We identified 12 cases that three evaluators further analysed. We also present the case of a 32-year-old woman diagnosed with uterine perforation and omentum involvement. The patient underwent a hysteroscopic procedure with resectioning the protruding omentum into the uterine cavity, followed by intrauterine device insertion. CONCLUSION This paper highlights the importance of a comprehensive gynaecological evaluation following a D&C procedure that includes a thorough clinical examination and a detailed ultrasound assessment. Healthcare providers should not overlook the diagnosis of omentum involvement in the presence of a history of intrauterine procedures.
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Affiliation(s)
- George Lucian Zorilă
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, Medgin, GINECHO Clinic, 200333 Craiova, Romania
| | - Răzvan Grigoraș Căpitănescu
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, Medgin, GINECHO Clinic, 200333 Craiova, Romania
| | - Roxana Cristina Drăgușin
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, Medgin, GINECHO Clinic, 200333 Craiova, Romania
| | - Anca-Maria Istrate-Ofițeru
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Histology, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
- Research Centre for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
| | - Elena Bernad
- Department of Obstetrics and Gynaecology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square no 2, 300041 Timisoara, Romania
- Clinic of Obstetrics and Gynaecology, “PiusBrinzeu” County Emergency Hospital, 300723 Timisoara, Romania
- Correspondence:
| | - Mădălina Dobie
- Lugoj Municipal Council, Medical Assistance-Education Service Romania, 305500 Lugoj, Romania
| | - Sandor Bernad
- Romanian Academy Timisoara Branch, Mihai Viteazul Avenue, 24, 300275 Timisoara, Romania
| | - Marius Craina
- Department of Obstetrics and Gynaecology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square no 2, 300041 Timisoara, Romania
- Clinic of Obstetrics and Gynaecology, “PiusBrinzeu” County Emergency Hospital, 300723 Timisoara, Romania
| | - Iuliana Ceaușu
- Department of Obstetrics and Gynaecology, “Carol Davila” University of Medicine and Pharmacy, “Dr I. Cantacuzno” Hospital, 020021 Bucharest, Romania
| | - Marius Cristian Marinaş
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, Medgin, GINECHO Clinic, 200333 Craiova, Romania
- Department of Anatomy, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
| | - Maria-Cristina Comănescu
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, Medgin, GINECHO Clinic, 200333 Craiova, Romania
- Department of Anatomy, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
| | - Marian Valentin Zorilă
- Department of Forensic Medicine, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
| | - Ileana Drocaș
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, Medgin, GINECHO Clinic, 200333 Craiova, Romania
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
| | - Elena Iuliana Anamaria Berbecaru
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
| | - Dominic Gabriel Iliescu
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, Medgin, GINECHO Clinic, 200333 Craiova, Romania
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Samantray SR, Mohapatra I. Small Bowel Prolapse a Rare Complication Following Unsafe Abortion. Cureus 2020; 12:e11260. [PMID: 33274137 PMCID: PMC7707891 DOI: 10.7759/cureus.11260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Small bowel prolapse through uterine perforation is a rare but severe complication of unsafe abortion. Early recognition of the bowel prolapse, aggressive resuscitation and prompt surgical intervention can reduce the morbidity and mortality related to these kinds of injuries. We present here a case of small intestine prolapse through uterine perforation following dilatation and curettage requiring intestinal resection. Efforts have to be made to reduce the number of unsafe abortions.
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Singla R, Gaba N, Naik AL, Singh A. Rupture of Unscarred Uterus With Intestinal Prolapse From Vagina Following Criminal Abortion. Cureus 2020; 12:e10601. [PMID: 33123421 PMCID: PMC7584304 DOI: 10.7759/cureus.10601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 21-year-old unmarried and primigravida female indulged in criminal abortion at 18 weeks of gestation with the help of a village midwife. Instrumentation was done, and it led to uterine perforation with prolapse of 200 cm of small bowel through vagina. She was managed with resection of 160 cm of necrotic small bowel, repair of the uterine defect, and end jejunostomy, which was anastomosed with distal ileum three months later. This case highlights the risks of illegal abortion and the primitive societal mindset that forces unmarried women to resort to such means.
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Affiliation(s)
- Rimpi Singla
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Nayana Gaba
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Anil L Naik
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Anju Singh
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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5
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Takeda A, Shibata M, Shinone S, Nakamura H. Emergency Laparoendoscopic Single-Site Surgery for Management of Iatrogenic Uterine Perforation: A Report of 3 Cases. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Mayu Shibata
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Sanae Shinone
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Hiromi Nakamura
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
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6
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Augustin G, Mijatovic D, Zupancic B, Soldo D, Kordic M. Specific small bowel injuries due to prolapse through vaginal introitus after transvaginal instrumental gravid uterus perforation: a review. J OBSTET GYNAECOL 2019; 39:587-593. [PMID: 30822180 DOI: 10.1080/01443615.2018.1540561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A small bowel prolapse through the vaginal introitus after a transvaginal instrumental gravid uterus perforation is a surgical emergency. To define the mechanisms of an irreversible, small bowel ischaemia due to small bowel prolapse through a vaginal introitus, ClinicalTrials.gov, PubMed, PubMed Central, and Google Scholar were searched. Out of the 81 articles screened, 28 cases of a small bowel evisceration through vaginal introitus were included. A small bowel obstruction severity grading was defined with risk factors; potential mechanisms of different severity grades after a transvaginal instrumental gravid uterine perforation with a vaginal evisceration. The duration of symptoms or a delay in the diagnosis did not change the incidence of the two most severe grades-mesenteric stripping and a small bowel degloving. Both obstruction types develop immediately during an instrumental abortion. The severity of obstruction does not influence the maternal outcome.
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Affiliation(s)
- Goran Augustin
- a Department of Surgery , University Hospital Centre Zagreb , Zagreb , Croatia.,b School of Medicine , University of Zagreb , Zagreb , Croatia
| | - Davor Mijatovic
- a Department of Surgery , University Hospital Centre Zagreb , Zagreb , Croatia.,b School of Medicine , University of Zagreb , Zagreb , Croatia
| | - Bozidar Zupancic
- c Department of Pediatric Surgery , Children's Hospital Zagreb , Zagreb , Croatia
| | - Dragan Soldo
- d Department of Gynecology and Obstetrics , University Hospital Mostar , Mostar , Bosnia and Herzegovina
| | - Mario Kordic
- e Department of Urology , University Hospital Mostar , Mostar , Bosnia and Herzegovina
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7
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Zafar H, Ameer H, Fiaz R, Aleem S, Abid S. Low Socioeconomic Status Leading to Unsafe Abortion-related Complications: A Third-world Country Dilemma. Cureus 2018; 10:e3458. [PMID: 30564537 PMCID: PMC6298628 DOI: 10.7759/cureus.3458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/16/2018] [Indexed: 11/05/2022] Open
Abstract
Introduction An unsafe abortion is a persistent, preventable dilemma. It is a procedure where an unintended pregnancy is terminated either by untrained individuals, or in an environment not meeting medical standards, or both, as defined by the World Health Organization (WHO). It endangers women in developing countries, where abortion is restricted either by law and culture or legally permitted but not easily accessible. Induced abortions are usually performed by unqualified and untrained individuals or are self-induced. Such incidents take place in unhygienic conditions and involve inappropriate methods or administration of medications. Even if carried out by medical experts, a clandestine abortion carries an additional risk, medical coverage is not immediately available in an emergency and the woman may not receive appropriate post-abortion attention. Induced abortion-related complications happen and the woman may hesitate to seek medical care. Unsafe abortion-induced complications contribute a major burden, such as increased hospital stay, drug costs, and an unusual delay of other operations on gynecological services in developing countries. The purpose of this study was to seek an association between low socioeconomic status and complications related to unsafe abortion. Materials and methods A total of 296 female patients of child-bearing age presented between 2012 and 2015 in the emergency department (ED), Nishtar Hospital, Multan, after an unsafe abortion, were included. Spontaneous miscarriages and abortions cases carried out on legal or medical grounds were excluded. Patient or their attendants (who usually present the real picture of incidents leading towards unsafe abortion) were interviewed for determinants leading to unsafe abortion. A detailed clinical assessment of the patient was done and complications like hemorrhage, uterine perforation, and bowel perforation were recorded along with basic demographic information such as age, gestational age, parity, and weight. Results There were 296 female patients in the study with a mean age 28.391 ± 4.57 (Range: 13-40 years). In a majority of patients, gravida and parity were 5-6. The mean weight was 60.283 ± 9.31 kilograms and the mean gestational age was 7.733 ± 2.45 weeks. The determinant in the shape of poor economic status was 71.6%. Hemorrhage was seen in 30.1% of the patients followed by uterine perforation (49.3%) and bowel perforation (45.6%). Conclusion Our results indicate that unsafe abortion is a major cause of maternal morbidity, mostly because the service is being sought from untrained healthcare providers in unhygienic conditions secondary to poor socioeconomic status. Since maternal morbidity due to unsafe abortion is a violation of a woman's basic human right: the right to life, there is a dire need to prevent these unwanted complications by improving the quality of the family planning program and providing safe abortion services.
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Affiliation(s)
- Hania Zafar
- Obstetrics and Gynecology, The Indus Hospital, Lahore, PAK
| | - Hina Ameer
- Obstetrics and Gynecology, Air Force Hospital, Shorkot, PAK
| | - Rahma Fiaz
- Family Medicine, District Headquarter Hospital, Sahiwal, PAK
| | - Saad Aleem
- Orthopedics, Nishtar Medical College and Hospital, Multan, PAK
| | - Shazia Abid
- Obstetrics and Gynecology, The Indus Hospital, Lahore, PAK
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8
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Hoysal DR, K H. Isolated Mesenteric Injury causing Ileal Devascularisation with Uterine Perforation following Termination of Pregnancy; A Case Report and Literature Review. Bull Emerg Trauma 2018; 6:376-378. [PMID: 30402530 PMCID: PMC6215067 DOI: 10.29252/beat-060418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Dileep Ramesh Hoysal
- Dileep Ramesh Hoysal, Assistant Professor, Department of Surgery, BGS GIMS, Bangalore,560060
| | - Hemashree K
- Dr Hemashree K, House Surgeon, Department of Surgery, BGS GIMS, Bangalore, 560060
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9
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Taylor D, Upadhyay UD, Fjerstad M, Battistelli MF, Weitz TA, Paul ME. Standardizing the classification of abortion incidents: the Procedural Abortion Incident Reporting and Surveillance (PAIRS) Framework. Contraception 2017; 96:1-13. [PMID: 28578150 DOI: 10.1016/j.contraception.2017.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/30/2017] [Accepted: 05/14/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To develop and validate standardized criteria for assessing abortion-related incidents (adverse events, morbidities, near misses) for first-trimester aspiration abortion procedures and to demonstrate the utility of a standardized framework [the Procedural Abortion Incident Reporting & Surveillance (PAIRS) Framework] for estimating serious abortion-related adverse events. STUDY DESIGN As part of a California-based study of early aspiration abortion provision conducted between 2007 and 2013, we developed and validated a standardized framework for defining and monitoring first-trimester (≤14weeks) aspiration abortion morbidity and adverse events using multiple methods: a literature review, framework criteria testing with empirical data, repeated expert reviews and data-based revisions to the framework. RESULTS The final framework distinguishes incidents resulting from procedural abortion care (adverse events) from morbidity related to pregnancy, the abortion process and other nonabortion related conditions. It further classifies incidents by diagnosis (confirmatory data, etiology, risk factors), management (treatment type and location), timing (immediate or delayed), seriousness (minor or major) and outcome. Empirical validation of the framework using data from 19,673 women receiving aspiration abortions revealed almost an equal proportion of total adverse events (n=205, 1.04%) and total abortion- or pregnancy-related morbidity (n=194, 0.99%). The majority of adverse events were due to retained products of conception (0.37%), failed attempted abortion (0.15%) and postabortion infection (0.17%). Serious or major adverse events were rare (n=11, 0.06%). CONCLUSIONS Distinguishing morbidity diagnoses from adverse events using a standardized, empirically tested framework confirms the very low frequency of serious adverse events related to clinic-based abortion care. IMPLICATIONS The PAIRS Framework provides a useful set of tools to systematically classify and monitor abortion-related incidents for first-trimester aspiration abortion procedures. Standardization will assist healthcare providers, researchers and policymakers to anticipate morbidity and prevent abortion adverse events, improve care metrics and enhance abortion quality.
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Affiliation(s)
- Diana Taylor
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, and School of Nursing, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612.
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612
| | - Mary Fjerstad
- National Abortion Federation, 1090 Vermont Avenue NW #1000, Washington, DC 20005
| | - Molly F Battistelli
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612
| | - Tracy A Weitz
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612
| | - Maureen E Paul
- Beth Israel Deaconess Medical Center, Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215
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Topfedaisi Özkan N, Erkan Sarı M, Görkem Ü, Bayramoğlu H, Akbay S, Mutlu Meydanlı M, Güngör T. Iatrogenic implantation of placental tissue after first trimester dilatation and curettage presenting as a uterine mass: A report of two cases. J OBSTET GYNAECOL 2017; 37:801-803. [PMID: 28325128 DOI: 10.1080/01443615.2017.1286301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nazlı Topfedaisi Özkan
- a Zekai Tahir Burak Women's Health , Education and Research Hospital, Gynecologic Oncology Unit , Ankara, Turkey
| | - Mustafa Erkan Sarı
- a Zekai Tahir Burak Women's Health , Education and Research Hospital, Gynecologic Oncology Unit , Ankara, Turkey
| | - Ümit Görkem
- b Department of Obstetrics and Gynecology , Faculty of Medicine, Hitit University , Çorum, Turkey
| | - Hatice Bayramoğlu
- c Zekai Tahir Burak Women Health Education and Research Hospital, Pathology Department , Ankara, Turkey
| | - Serap Akbay
- c Zekai Tahir Burak Women Health Education and Research Hospital, Pathology Department , Ankara, Turkey
| | - Mehmet Mutlu Meydanlı
- a Zekai Tahir Burak Women's Health , Education and Research Hospital, Gynecologic Oncology Unit , Ankara, Turkey
| | - Tayfun Güngör
- b Department of Obstetrics and Gynecology , Faculty of Medicine, Hitit University , Çorum, Turkey
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11
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Suzuki S. Intestinal Injury Associated With Uterine Perforation due to Surgical Abortion in Japan. Gastroenterology Res 2017; 10:63. [PMID: 28270881 PMCID: PMC5330697 DOI: 10.14740/gr766w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Shunji Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, 5-11-12 Tateishi, Katsushika-ku, Tokyo 124-0012, Japan.
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12
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De Cicco A, Mascilini F, Ludovisi M, De Cicco F, Scambia G, Testa AC. Uterine perforation and small bowel incarceration 11 months after dilatation and curettage: sonographic and surgical findings. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:278. [PMID: 26935777 DOI: 10.1002/uog.15904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/26/2016] [Indexed: 06/05/2023]
Affiliation(s)
- A De Cicco
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - F Mascilini
- Division of Gynecology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - M Ludovisi
- Division of Gynecology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - F De Cicco
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - G Scambia
- Division of Gynecology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - A C Testa
- Division of Gynecology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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13
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Tokuda H, Nakago S, Kato H, Oishi T, Kotsuji F. Bleeding in the retroperitoneal space under the broad ligament as a result of uterine perforation after dilatation and curettage: Report of a case. J Obstet Gynaecol Res 2017; 43:779-782. [PMID: 28109122 DOI: 10.1111/jog.13252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 11/08/2016] [Indexed: 11/28/2022]
Abstract
Uterine perforation, a complication of dilation and curettage, is typically recognized immediately after the procedure by clinical symptoms of peritoneal irritation resulting from intraperitoneal bleeding. Our patient complained of having an uncomfortable feeling, slight dizziness, palpitation in the sitting position and abdominal discomfort but did not show signs of peritoneal irritation 24 h after dilation and curettage. However, she suddenly complained of abdominal pain. Tenderness and rebound tenderness were detected at the lower abdominal wall. Ultrasonography and magnetic resonance imaging suggested uterine perforation. When the abdominal cavity was opened, a hematoma under the broad ligament of the uterus, laceration of the side wall of the uterine cervix and a small amount of bloody ascites and small clots in the abdominal cavity were observed. The uterine cervical wall was sutured. Physicians should postpone discharge and observe the clinical course carefully when a patient complains of inexplicable discomfort after dilation and curettage.
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Affiliation(s)
- Hisato Tokuda
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Satoshi Nakago
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Hiroki Kato
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Tetsuya Oishi
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Fumikazu Kotsuji
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Osaka, Japan
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14
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Faucher P. [Complications of termination of pregnancy]. ACTA ACUST UNITED AC 2016; 45:1536-1551. [PMID: 27816250 DOI: 10.1016/j.jgyn.2016.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 11/15/2022]
Abstract
The legalization of abortion in France allowed to disappear almost maternal deaths caused by induced abortions. Nevertheless, the practice of abortion in a medical framework is encumbered with a number of immediate complications. Similarly, the late consequences of the practice of surgical abortion have generated an abundant literature, which it is important to analyse, both to meet the legitimate concerns of patients as to prevent any spread of false ideas under the influence of movements opposed to abortion.
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Affiliation(s)
- P Faucher
- Unité fonctionnelle d'orthogénie, hôpital Trousseau, 26, rue du Dr-Arnold-Netter, 75571 Paris cedex 12, France.
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15
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Chandi A, Jain S, Yadav S, Gurawalia J. Vaginal evisceration as rare but a serious obstetric complication: A case series. Case Rep Womens Health 2016; 10:4-6. [PMID: 29593982 PMCID: PMC5863029 DOI: 10.1016/j.crwh.2016.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction Gut prolapse through vagina is rare complication with only few cases reported in the literature. This article highlights untrained professionals induced obstetrical trauma as a cause of vaginal evisceration leading to serious but preventable complications. Presentation of Case Case 1: A 27 years old female, P2L0, had full term vaginal delivery of an IUD baby and presented 4 days later with small bowel evisceration through posterior vaginal wall. Case 2: A 24 years old female, P1A1 had underwent unsafe abortion and presented in shock, with small bowel evisceration through anterior uterine wall. Case 3: A 26 years female, P2A1, underwent evacuation for incomplete abortion and presented with omental prolapse through anterior uterine wall. Discussion Obstetrical trauma with associated evisceration of intraabdominal contents is a potentially serious complication that requires surgical intervention. General awareness may decrease these unsafe practices and thus would have impact in reducing maternal morbidity and mortality.
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Affiliation(s)
- Anadeep Chandi
- Department of Obstetric and Gynaecology, Pt. B. D. Sharma, PGIMS, Rohtak, Haryana, India
| | - Shaveta Jain
- Department of Obstetric and Gynaecology, Pt. B. D. Sharma, PGIMS, Rohtak, Haryana, India
| | - Sakshi Yadav
- Department of Obstetric and Gynaecology, Pt. B. D. Sharma, PGIMS, Rohtak, Haryana, India
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16
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Kallidonis P, Panagopoulos V, Kyriazis I, Vasilas M, Liatsikos E. Transvaginal specimen removal in minimally invasive surgery. World J Urol 2016; 34:779-87. [DOI: 10.1007/s00345-016-1770-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 01/16/2016] [Indexed: 02/07/2023] Open
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17
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Begum J, Samal S, Ghose S. Unusual Complication of Surgical Abortion with Pelvic Extrusion of Fetal Head: A Case Report. J Clin Diagn Res 2015; 9:QD11-2. [PMID: 26675988 DOI: 10.7860/jcdr/2015/15759.6780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/09/2015] [Indexed: 11/24/2022]
Abstract
Unsafe abortion is one of the causes of maternal mortality and morbidity in developing countries. The complications mostly results following unsafe abortion procedure done by unskilled provider with or without minimal medical knowledge in rural part of developing countries. These complications can endanger the life of mother if proper medical or surgical interventions are not offered in time. A majority of these complications remains confidential. The uterine perforation is one of the serious but preventable complications of surgical abortion. A 21-year-old woman G4P2L2A1, presented in the emergency ward with complaints of lower abdominal pain for four days after attempting twice surgical termination of pregnancy at 19 weeks of gestation for an unwanted pregnancy. Transabdominal sonography and MRI revealed uterine rent with pelvic extrusion of fetal head. Emergency laparotomy with removal of fetal head and uterine rent repair was done. This case illustrates the importance of maintaining a high index of suspicion by the gynaecologist for uterine perforation in patient presenting with abdominal pain a few days after undergoing surgical abortion, also shows the complementary role of sonography and MRI in evaluation of the similar patient and this case also highlights the rampant illegal unsafe abortion procedure in rural India despite of legalization of abortion act.
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Affiliation(s)
- Jasmina Begum
- Associate Professor, Department of Obstetrics and Gynecology, Mahatama Gandhi Medical College and Research Institute , Puducherry, India
| | - Sunita Samal
- Professor, Department of Obstetrics and Gynecology, Mahatama Gandhi Medical College and Research Institute , Puducherry, India
| | - Seetesh Ghose
- Professor, Department of Obstetrics and Gynecology, Mahatama Gandhi Medical College and Research Institute , Puducherry, India
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18
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Prolapse of the small intestine from the uterine perforation at dilatation and curettage. Case Rep Obstet Gynecol 2014; 2014:164356. [PMID: 24716029 PMCID: PMC3970256 DOI: 10.1155/2014/164356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 01/29/2014] [Indexed: 11/29/2022] Open
Abstract
Dilatation and curettage (D&C) sometimes causes uterine perforation, which usually does not cause a serious problem. Here, we report uterine perforation caused by D&C, in which the small intestine prolapsed from the uterus, requiring intestinal resection. D&C was performed for missed abortion at 9 weeks. After dilating the cervix, forceps grasped tissue that, upon being pulled, resulted in the intestine being prolapsed into the vagina. Laparotomy revealed a perforation at the low anterior uterine wall, through which the ileum had prolapsed. The mesentery of the prolapsed ileum was completely detached and the ileum was necrotic, which was resected. The uterus and the intestine were reconstructed. Although intestinal prolapse is considered to be caused by “unsafe” D&C performed by inexperienced persons or even by nonphysicians in developing countries, this occurred in a tertiary center of a developed country. We must be aware that adverse events such as uterine perforation with intestinal prolapse can occur even during routine D&C.
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