Uterine perforation and bowel incarceration following a second trimester abortion

Uterine perforation is a rare but potentially life-threatening complication of elective abortion, often occurring without immediate symptoms.

This case report describes a 32-year-old woman who developed small bowel incarceration within the uterine cavity following a second-trimester abortion. She presented five days post-procedure with acute abdominal pain, nausea, and vomiting. Physical and laboratory examinations indicated elevated white blood cell count and Creactive protein levels, while imaging studies, including CT scans, revealed a dilated small bowel loop incarcerated within the uterus. Surgical intervention was performed, identifying a uterine defect and an incarcerated small intestine, which was well vascularized. After reducing the bowel and repairing the uterine perforation, the patient made a full recovery.

Uterine perforation during abortion has a reported incidence of 0.05 % to 1.9 %, with second-trimester procedures associated with higher complication rates. This case underscores the importance of recognizing such rare complications, as symptoms like pain, vomiting, and fever can delay diagnosis. Differential diagnoses include retained products of conception, pelvic inflammatory disease, and nongynecological causes of abdominal pain. Imaging, particularly CT scans, is essential for diagnosing uterine perforation and bowel incarceration. Treatment typically involves timely surgical intervention to prevent further complications such as bowel necrosis, infection, or death. Strategies to reduce the risk of uterine perforation include careful preoperative evaluation, slow cervical dilation, and meticulous surgical technique.

This report highlights the significance of early diagnosis and intervention to reduce morbidity and mortality associated with uterine perforation following abortion.