Delayed Ileal Perforation With Psoas Abscess and Fistulization Into the Inferior Vena Cava Post-Dilation and...

Dilation and curettage (D&C) is a common gynecological procedure, but it carries a risk of rare and catastrophic complications. We report the case of a 24-year-old female who presented with a 3-month history of persistent low-grade fever and progressive abdominopelvic pain following a D&C for a spontaneous miscarriage. Initial evaluations were inconclusive. A subsequent contrast-enhanced computed tomography (CECT) scan revealed extensive bilateral psoas abscesses and, critically, the pathognomonic finding of free air within the lumen of the inferior vena cava (IVC), confirming an enterovascular fistula. An emergency exploratory laparotomy identified a contained ileal perforation with fistulous tracts extending to the right psoas muscle and the IVC. The patient was successfully managed with segmental ileal resection, abscess drainage, and primary suture repair of the IVC fistula. This case highlights a life-threatening, delayed iatrogenic complication of uterine instrumentation and underscores that the radiological finding of intravascular gas is a surgical emergency, mandating immediate intervention to prevent fatal sepsis or systemic air embolism.