Sp. Kambiss et al., Uterine perforation resulting in bowel infarction: Sharp traumatic bowel and mesenteric injury at the time of pregnancy termination, MILIT MED, 165(1), 2000, pp. 81-82
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.