Traumatic Uterine Rupture in a Nonpregnant Patient: A Case Report

Traumatic uterine rupture is a rare and easily overlooked condition. Most cases of traumatic uterine rupture have been reported to occur in pregnancy. Here, we reported the case of a 14-year-old nonpregnant girl who presented to the emergency department with hemorrhagic shock due to multiple traumatic injuries after falling from a height during a suicide attempt. Initial resuscitation stabilized the patient's vital signs. A whole-body computed tomography (CT) scan revealed bilateral pneumothorax, multiple rib fractures, a grade III renal injury, a liver injury, and an unstable pelvic fracture. Although a poorly enhancing area was identified in the anterior wall of the uterine body on the initial CT scan, uterine rupture was not included in the active differential diagnosis at that time, as clinical priorities were directed toward other life-threatening injuries. Persistent unexplained hemoperitoneum led to a repeat CT scan performed on hospital day 4 and prompted magnetic resonance imaging on hospital day 7, which confirmed complete full-thickness rupture of the anterior uterine wall. Laparoscopic uterine repair was performed on hospital day 14. This case highlighted the importance of not dismissing uterine CT scan findings as incidental in female patients with unstable pelvic fractures, even when pregnancy has been excluded, and of considering pelvic magnetic resonance imaging scans when hemoperitoneum persists without a fully identified source. We also discussed the cognitive processes-including anchoring bias, confirmation bias, and task fixation (search satisficing)-that contributed to the delayed recognition of this diagnosis.