Costumbrado John, Snyder Leah, Ghassemzadeh Sassan, Ng Daniel
University of California, Riverside, School of Medicine, Riverside, CA.
Riverside Community Hospital, Department of Emergency Medicine, Riverside, CA.
J Educ Teach Emerg Med. 2024 Apr 30;9(2):V6-V9. doi: 10.21980/J83643. eCollection 2024 Apr.
Uterine perforation is a rare but potentially life-threatening complication of gynecologic procedures. Serious complications include hemorrhage, infection, and injury to surrounding organ systems (eg, gastrointestinal, urological, vascular, etc.). Risk factors include advanced maternal age, prior gynecologic surgeries, and other anatomical features that impact the difficulty of accessing the uterine cavity. In this case report, we discuss a patient who presented to the emergency department (ED) with diffuse abdominal pain and vaginal bleeding that occurred after an elective dilation and curettage (D&C) for a termination of pregnancy. The diagnosis was suspected clinically and confirmed by imaging including ultrasound (US) and computed tomography (CT) of the abdomen and pelvis. The patient was managed operatively with a multidisciplinary approach including Gynecology, General Surgery, and Urology. The patient was stabilized and eventually discharged. Uterine perforation should be included in the differential for patients with a history of recent gynecologic instrumentation presenting with abdominal pain and vaginal bleeding. The stabilization of these patients requires aggressive volume resuscitation, controlling the source of bleeding, and emergent surgical consultation.
Gynecology, vaginal bleeding, ultrasound, computed tomography.
子宫穿孔是妇科手术中一种罕见但可能危及生命的并发症。严重并发症包括出血、感染以及对周围器官系统（如胃肠道、泌尿系统、血管等）的损伤。危险因素包括产妇年龄较大、既往妇科手术史以及其他影响进入子宫腔难度的解剖特征。在本病例报告中，我们讨论了一名患者，该患者因选择性刮宫术（D&C）终止妊娠后出现弥漫性腹痛和阴道出血而就诊于急诊科（ED）。临床怀疑诊断并通过包括腹部和盆腔超声（US）及计算机断层扫描（CT）在内的影像学检查得以证实。该患者通过包括妇科、普通外科和泌尿外科的多学科方法进行手术治疗。患者病情稳定，最终出院。对于近期有妇科器械操作史且出现腹痛和阴道出血的患者，鉴别诊断应包括子宫穿孔。这些患者的病情稳定需要积极的容量复苏、控制出血来源并紧急进行外科会诊。
妇科、阴道出血、超声、计算机断层扫描。
