Specific small bowel injuries due to prolapse through vaginal introitus after transvaginal instrumental gravid uterus perforation: a review

An Unusual Presentation of Intestinal Obstruction: Uterine Perforation and Bowel Herniation Following Manual Vacuum Aspiration

Introduction

Uterine perforation following manual vacuum aspiration (MVA) of early pregnancy is an uncommon occurrence. It is even more unusual to be complicated by bowel herniation and intestinal obstruction. Proper evaluation and intervention are required to ameliorate the attendant morbidity.

Case Report

We reported a case of a 39-year-old known retroviral disease P1+[1] nonalive who presented 2 weeks after MVA with clinical and radiological features of complete small bowel obstruction. She was resuscitated and had a laparotomy that revealed a herniated loop of small bowel through a uterine perforation. Resection and anastomosis were done; she made a full recovery and was subsequently discharged on the 7th postoperative day.

Conclusion

Public enlightenment, safe sex practices, and public access to health care covered by health insurance would reduce the incidence of this uterine perforation.

Transvaginal strangulated bowel evisceration through uterine perforation due to unsafe abortion: a case report and literature review

Background

Induced abortion, whether therapeutic or elective, is a surgical procedure frequently practiced worldwide. It is a significant cause of maternal morbidity and mortality. When the procedure is performed in precarious conditions, by unqualified personnel, it leads to serious consequences, including uterine perforation and its associated lesions. Its management remains a medico-surgical emergency.

Case presentation

We present two cases of unsafe abortions performed by cervical dilatation and intrauterine curettage which resulted in uterine perforation and intestinal evisceration through the vagina leading to acute intestinal obstruction. Both patients underwent intensive resuscitation followed by an emergency laparotomy. The first case was a 26-year-old woman living in rural Cameroon. Following a procedure of termination of her pregnancy, the patient noted the presence of bowel at the vaginal introitus associated with signs of intestinal obstruction. She was transferred to a specialized center was after 4 days later of the onset of the evisceration. Considering the gangrened eviscerated terminal ileum, a right hemicolectomy with anastomosis was performed, as well as a suture of the uterine perforation. The second patient was an 18-year-old African living as a refugee in Cameroon. She was referred for abdominal pain in the context of intestinal obstruction with a viable jejunal loop extruding through the vagina. A simple jejunal resection was performed with end-to-end anastomosis and suture of the uterine perforation. In both cases, the postoperative course was uneventful.

Conclusions

Uterine perforation is a serious complication of intrauterine gynecological procedures and instrumental abortion in particular. It can lead to evisceration of the intra-abdominal viscera through the uterine perforation. It is therefore a real surgical emergency with multiple and fatal consequences.