Souayeh Nesrine, Rouis Hadhami, Chermiti Amal, Lika Amira, Mbarki Chaouki, Bettaieb Hajer
Department of Gynecology and Obstetrics, Hospital of Ben Arous, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
Department of Gynecology and Obstetrics, Hospital of Ben Arous, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
Int J Surg Case Rep. 2024 Sep;122:110065. doi: 10.1016/j.ijscr.2024.110065. Epub 2024 Jul 20.
Uterine perforation and bowel injury are rare but potentially life-threatening complications of surgical abortion. Early diagnosis results in easier management and better prognosis. We report here a case of a 39-year-old presented with peritonitis secondary to traumatic bowel perforation after second-trimester surgical abortion.
A 39-year-old Gravida 3 Para 2 presented with acute abdominal pain two days after second trimester induced abortion. On physical examination, the patient was febrile and hypotensive with diffuse abdominal tenderness. Emergency abdomino-pelvic-CT showed generalized peritonitis with pneumoperitoneum. The patient underwent an emergency laparotomy. Per operative exploration revealed a perforation of the fundus of the uterus and the sigmoid portion of the large intestine, resulting in stercoral peritonitis. We proceeded with thorough cleansing of the abdominal cavity with physiological serum, followed by partial colectomy including the perforated sigmoid and a Hartmann's procedure. The patient was admitted to the post-operative intensive care unit for 18 days and discharged on day 27 after the surgery. Intestinal continuity restoration was performed six months after the surgery.
Given the severity of second trimester pregnancy termination complications, efforts should be made to promote contraception and medical first-trimester pregnancy termination. Any unusual symptom after surgical induced abortion should lead to suspect uterine perforation.
Uterine perforation during induced abortion is usually asymptomatic and can generally be managed conservatively. However, bowel injury may result in peritonitis, requiring immediate laparotomy and resection of perforated bowel. CT-scans can help diagnose this rare complication.
子宫穿孔和肠损伤是人工流产手术中罕见但可能危及生命的并发症。早期诊断有助于更轻松的管理和更好的预后。我们在此报告一例39岁女性，在孕中期人工流产术后因外伤性肠穿孔继发腹膜炎。
一名39岁、孕3产2的女性在孕中期人工流产术后两天出现急性腹痛。体格检查时，患者发热、低血压，全腹压痛。急诊腹盆腔CT显示弥漫性腹膜炎伴气腹。患者接受了急诊剖腹手术。术中探查发现子宫底部和大肠乙状结肠部分穿孔，导致粪便性腹膜炎。我们先用生理盐水彻底清洗腹腔，随后进行包括穿孔乙状结肠的部分结肠切除术及哈特曼手术。患者术后入住重症监护病房18天，术后第27天出院。术后六个月进行了肠道连续性恢复手术。
鉴于孕中期终止妊娠并发症的严重性，应努力推广避孕措施及孕早期药物流产。人工流产术后出现任何异常症状都应怀疑子宫穿孔。
人工流产术中的子宫穿孔通常无症状，一般可保守处理。然而，肠损伤可能导致腹膜炎，需要立即剖腹手术并切除穿孔肠段。CT扫描有助于诊断这种罕见并发症。
