SONOGRAPHIC DETECTION OF UTERINE PERFORATION IN SURGICAL ABORTIONS: CASE REPORT FROM A DEVELOPING COUNTRY.

Abstract

Uterine perforation is a rare major complication of surgical abortion which can be detected by ultrasound. In the last four decades, over 70% of case reports on uterine perforation in surgical abortions were from developing countries. Yet ultrasound was rarely used in detecting uterine perforation prior to laparotomy. This case report presents two cases of uterine perforation in surgical abortions which were detected by ultrasound prior to laparotomy. In the first case, a 34-year old woman was referred to our facility as a case of hypovolaemic shock following termination of pregnancy. An ultrasound examination performed to exclude an intra-abdominal abscess collection revealed a 1.2cm defect in the fundal region of the uterus with extrusion of abdominal contents into the endometrial cavity through the defect. In the second case, 31-year woman presented with a week's history of vomiting, abdominal pain, abdominal distension and absolute constipation 2 weeks after an evacuation of the uterus for a spontaneous abortion at 7 weeks' gestation. Transabdominal ultrasound showed a defect about 1.4cm wide at the fundus of the uterus, with a structure extending from the abdominal cavity through the defect and into the endometrial cavity. It also showed distension of multiple bowel loops within the abdominal cavity. Sonographic detection of uterine perforation led to appropriate management in both cases. In developing countries, where the incidence of major complications of abortion is still very high, utilizing ultrasound can be helpful in detecting complications such as uterine perforation.