Intestinal adhesion due to previous uterine surgery as a risk factor for delayed diagnosis of uterine rupture: a case report

Abstract

IntroductionUterine rupture is a life-threatening condition both to mothers and fetuses. Its early diagnosis and treatment may save their lives. Previous myomectomy is a high risk factor for uterine rupture. Intestinal adhesion due to previous myomectomy may also prevent early diagnosis of uterine rupture.Case presentationA 38-year-old primiparous non-laboring Japanese woman with a history of myomectomy was admitted in her 34th week due to lower abdominal pain. Although the pain was slight and her vital signs were stable, computed tomography revealed massive fluid collection in her abdominal cavity, which led us to perform a laparotomy. Uterine rupture had occurred at the site of the previous myomectomy; however, the small intestine was adhered tightly to the rupture, thus masking it. The baby was delivered through a low uterine segment transverse incision. The ruptured uterine wall was reconstructed.ConclusionIntestinal adhesion due to a prior myomectomy occluded a uterine rupture, possibly masking its symptoms and signs, which may have prevented early diagnosis.

Letter to ‘Silent uterine rupture occluded by intestinal adhesions following laparoscopic myomectomy: A case report’: Do some remain permanently silent?

“…As was cited, we also previously reported a similar case of uterine rupture: the intestine/mesentery covered/occluded the rupture, preventing catastrophe. 2 The case described by Fukutani et al showed no bleeding, and rupture was revealed at term cesarean section, whereas our case had uterine contractions and hemoperitoneum, prompting preterm cesarean section. If the patient of Fukutani et al had experienced uterine contractions, rupture may have become larger, causing bleeding/hemoperitoneum, similar to our case.…”

Adenomyomectomy, curettage, and then uterine artery pseudoaneurysm occupying the entire uterine cavity

“…Uterine surgery, especially myomectomy, sometime causes adverse events in subsequent pregnancies. Of these, uterine rupture has been a major concern as previously described, 10,11 which may hold true also to adenomyomectomy. 5 Although we observed no causeeffect relation between adenomyomectomy and UAP, it is reasonable to assume it.…”

Response to ‘Silent uterine rupture occluded by intestinal adhesions following laparoscopic myomectomy: A case report’: Do some remain permanently silent?

“…The case described by Dr. Kuwata et al also showed intestinal adhesion that covered and occluded a uterine rupture. Their case was symptomatic, while ours was asymptomatic . Dr. Matsubara and Dr. Morita suggested that, regardless of the clinical symptoms, the occlusion of a uterine rupture was dependent on the trigger: uterine contractions.…”

“…Thus, the uterine rupture was not diagnosed until the patient underwent cesarean section. In the case described by Kuwata et al , intestinal adhesion might have masked the symptoms and signs and delayed the diagnosis . In another reported case, the incarcerated omentum occluded the uterine perforation after surgery in a patient who underwent dilatation and evacuation/curettage .…”