Laparoscopy in the management of uterine perforation

The introduction of laparoscopy as a routine diagnostic tool for pelvic disorders has prompted its use in the management of uterine perforation as well. A retrospective review of 52 patients with uterine perforation secondary to curettage is presented. In 23 (44.2%) the curettage was discontinued, and the postperforation course was uneventful. Eight patients (15.4%) underwent immediate exploratory laparotomy without laparoscopy; in three of them no internal organ injury or bleeding was found. Eighteen patients (34.6%) underwent postperforation laparoscopy; seven of these women underwent subsequent laparotomy. The indications and objectives of postperforation laparoscopy are outlined. Its judicious use allows proper selection of patients for exploratory laparotomy.