Uterine perforation resulting in bowel infarction: Sharp traumatic bowel and mesenteric injury at the time of pregnancy termination

Background: By law, elective terminations of pregnancy are not performed in U,S, military institutions. However, in the civilian sector, more than a m illion abortions are performed each year, some of which are on military ben eficiaries, Although complications are relatively rare, patients not uncomm only present for follow-up care to their military installation, We report t he case of a patient who presented after a second-trimester elective aborti on and was found to have suffered uterine perforation with mesenteric and b owel injury that required bowel resection, Case: An 18-year-old gravida 1 para 6 female presented from an outlying fac ility 1 week after elective termination at 18 weeks of gestation with compl aints of severe abdominal pain, nausea, and vomiting. Exploratory laparotom y for presumed bowel obstruction revealed uterine perforation and bowel dev italization and necrosis, which required small bowel resection, Fetal bones were discovered within the surgical specimen. Conclusion: Morbid, even pot entially fatal, complications can occur as a result of pregnancy terminatio n. With second-trimester procedures, perforation can result in injury to ab dominal viscera from the perforating instruments or even from sharp fetal b ony structures, Military gynecologic surgeons, who are not in abortion prac tice, must nevertheless be cognizant of the potential for perforation leadi ng to serious visceral injury.