Small bowel obstruction following perforation of the uterus at induced abortion

Abstract

BACKGROUND: Unsafe abortion is an important contributor to maternal morbidity and mortality. OBJECTIVE: To present a case of small bowel obstruction following perforation of the uterus at induced abortion. METHODS: A 36-year-old woman, presented at a private hospital, with abdominal pain and weight loss. She had full clinical assessment and laboratory investigations which indicated small bowel obstruction following perforation of the uterus at induced abortion, and was commenced on treatment. RESULTS: She was para 5+0. Her main complaints were abdominal and weight loss following induced abortion of a 12-week pregnancy, four months prior to presentation. At presentation the tools (ultrasound scan, plain abdominal radiograph and barium enema) used for diagnoses only suggested some form of intestinal obstruction and were unremarkable. Correct diagnoses indicating small bowel obstruction was only made at laparotomy. An exploratory laparotomy, adhesiolysis, small bowel resection, end to end anastomosis and bowel decompression was done after bowel preparation. CONCLUSION: Laparotomy has an enviable place in bowel injuries secondary to uterine perforation especially when there is a diagnostic dilemma.

A Diagnostic Conundrum - Small bowel obstruction from undiagnosed endometriosis following uterine perforation

“…Small bowel obstruction after uterine perforation has not been well documented, we were only able to find one case of bowel obstruction following uterine perforation, reported over 10 years ago [ 8 ]. A review found that in documented cases, clinical presentation and time of presentation following uterine perforation varies significantly [ 9 ].…”

Gangrenous Bowel Prolapse-Disaster of Dilatation and Curettage

“…Others include hemorrhage, retained product of conception, infections, septic shock, anemia and reaction to abortificients used during procurement of the abortion. The high rate of morbidities and mortalities associated with abortions are mostly from above complications [2,5]. Long term complications include chronic pelvic pain, chronic pelvic inflammatory diseases, and increased risk of ectopic pregnancies, secondary infertility and psycho-social morbidities [1,5,6].…”

“…To the victim, it compromises her health status and wellbeing, which could consequently affect the well-being of her family in particular and the community in general [5][6][7]. Complications resulting from induced abortion include uterine perforation, damage to the cervix and bowel perforation or prolapse.…”