Silent uterine rupture occluded by intestinal adhesions following laparoscopic myomectomy: A case report

Abstract

We present a rare asymptomatic case in which intestinal adhesions covered and occluded a site of uterine rupture, which was found during cesarean section. The patient had undergone laparoscopic myomectomy 5 years previously. However, detailed antenatal ultrasound and magnetic resonance imaging examinations revealed no uterine or placental abnormalities. It is thought that uterine rupture was not detected due to intestinal adhesions, which had occurred following the previous surgery. The present case suggests that women who conceive after laparoscopic myomectomy may be at risk of silent uterine rupture. However, detection of the silent uterine rupture during pregnancy may be limited, even with detailed imaging.

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

“…Although, to our knowledge, only two patients with such occluded rupture have been reported (the patient described by Fukutani et al 1 and our patient 2 ), we believe that some cases of such uterine rupture may remain unnoticed/unreported. In the case described by Fukutani et al, if the uterus had remained un-exteriorized, 'posterior' uterine perforation/rupture may have gone unrecognized.…”

“…Dear Editor, Fukutani et al 1 reported silent uterine rupture: rupture was covered/occluded by the intestine and mesentery, making it asymptomatic. As was cited, we also previously reported a similar case of uterine rupture: the intestine/mesentery covered/occluded the rupture, preventing catastrophe.…”

Characteristics of uterine rupture after laparoscopic surgery of the uterus: clinical analysis of 10 cases and literature review

“…Additionally, ultrasound examination resulted in a missed diagnosis in four patients, illustrating that diagnosis can be very difficult in the early stage. 23 , 24 Most cases were incidentally found during cesarean section for fetal distress. Therefore, patients with any suspected risk factors related to UR should be carefully evaluated and promptly treated if necessary.…”

Rotura uterina: uma revisão de literatura

“…Mulheres que concebem após realização de ML podem apresentar risco de RU silenciosa. No entanto, a detecção da RU silenciosa durante a gravidez pode ser limitada, mesmo com exames de imagem detalhados 28 . A laceração uterina difere de uma RU clássica.…”