Case report: Peritonitis secondary to traumatic bowel perforation during second-trimester surgical abortion

TL;DR

A 39-year-old woman developed peritonitis after a second-trimester surgical abortion due to a traumatic bowel perforation, requiring emergency surgery and a long recovery.

Contribution

This case report highlights the rare but severe complication of bowel injury following uterine perforation during second-trimester surgical abortion.

Findings

Uterine and bowel perforation after surgical abortion can lead to stercoral peritonitis requiring emergency laparotomy.

CT scans are recommended to detect traumatic injuries following surgical abortion.

Early diagnosis and surgical intervention improve prognosis in such cases.

Abstract

Uterine perforation and bowel injury are rare but potentially life-threatening complications of surgical abortion. Early diagnosis results in easier management and better prognosis. We report here a case of a 39-year-old presented with peritonitis secondary to traumatic bowel perforation after second-trimester surgical abortion.

A 39-year-old Gravida 3 Para 2 presented with acute abdominal pain two days after second trimester induced abortion. On physical examination, the patient was febrile and hypotensive with diffuse abdominal tenderness. Emergency abdomino-pelvic-CT showed generalized peritonitis with pneumoperitoneum. The patient underwent an emergency laparotomy. Per operative exploration revealed a perforation of the fundus of the uterus and the sigmoid portion of the large intestine, resulting in stercoral peritonitis. We proceeded with thorough cleansing of the abdominal cavity with physiological serum, followed by partial colectomy including the perforated sigmoid and a Hartmann's procedure. The patient was admitted to the post-operative intensive care unit for 18 days and discharged on day 27 after the surgery. Intestinal continuity restoration was performed six months after the surgery.

Given the severity of second trimester pregnancy termination complications, efforts should be made to promote contraception and medical first-trimester pregnancy termination. Any unusual symptom after surgical induced abortion should lead to suspect uterine perforation.

Uterine perforation during induced abortion is usually asymptomatic and can generally be managed conservatively. However, bowel injury may result in peritonitis, requiring immediate laparotomy and resection of perforated bowel. CT-scans can help diagnose this rare complication.

•Uterine perforation secondary to induced abortion is a rare complication•Computed tomography is the recommended whenever traumatic injury to the surrounding organs is suspected following surgical induced abortion.•Surgical management of uterine perforation is necessary when injury to other organs is suspected.

Uterine perforation secondary to induced abortion is a rare complication

Computed tomography is the recommended whenever traumatic injury to the surrounding organs is suspected following surgical induced abortion.

Surgical management of uterine perforation is necessary when injury to other organs is suspected.

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