# Delayed Ileal Perforation With Psoas Abscess and Fistulization Into the Inferior Vena Cava Post‐Dilation and Curettage—A Case Report

## TL;DR

A rare case of delayed ileal perforation and fistula into the inferior vena cava following a dilation and curettage procedure is reported, highlighting the importance of prompt diagnosis and treatment.

## Contribution

This case report presents a rare iatrogenic complication of D&C with enterovascular fistula and emphasizes intravascular gas as a critical surgical emergency sign.

## Key findings

- A 24-year-old patient developed a life-threatening ileal perforation and fistula into the IVC after a D&C.
- Contrast-enhanced CT identified free air in the IVC, confirming an enterovascular fistula.
- The patient was successfully treated with ileal resection, abscess drainage, and IVC repair.

## Abstract

Dilation and curettage (D&C) is a common gynecological procedure, but it carries a risk of rare and catastrophic complications. We report the case of a 24‐year‐old female who presented with a 3‐month history of persistent low‐grade fever and progressive abdominopelvic pain following a D&C for a spontaneous miscarriage. Initial evaluations were inconclusive. A subsequent contrast‐enhanced computed tomography (CECT) scan revealed extensive bilateral psoas abscesses and, critically, the pathognomonic finding of free air within the lumen of the inferior vena cava (IVC), confirming an enterovascular fistula. An emergency exploratory laparotomy identified a contained ileal perforation with fistulous tracts extending to the right psoas muscle and the IVC. The patient was successfully managed with segmental ileal resection, abscess drainage, and primary suture repair of the IVC fistula. This case highlights a life‐threatening, delayed iatrogenic complication of uterine instrumentation and underscores that the radiological finding of intravascular gas is a surgical emergency, mandating immediate intervention to prevent fatal sepsis or systemic air embolism.

Persistent symptoms after dilation and curettage (D&C) warrant high suspicion for occult bowel injury. If perforation is suspected intraoperatively, 24‐h observation is prudent. The finding of intravascular gas on imaging confirms an enterovascular fistula—a surgical emergency requiring immediate intervention to prevent fatal sepsis or air embolism.