Omental Herniation through Uterine Perforation due to Unsafe Abortion: A Case Report

Abstract

Post-abortion complications are a significant cause of maternal morbidity and mortality when conducted by untrained persons in sub-standard settings, which are commonly seen in Low and Middle-Income Countries (LMICs). The presentation depends on the type and extent of the injury but at times may be misleading and delayed recognition resulting in fatal complications. Uterine perforation is one of the uncommon complications of unsafe abortion. The authors report a case of 26-year-old female patient, Gravida 2, para 1 admitted with a history of bleeding per vaginum for the past five days. A detailed Ultrasonography (USG) was done by an ultrasonologist who confirmed the presence of a small rent in the uterine wall and the intrauterine product as a continuation of the omentum. An emergency laparotomy was performed and intraoperative findings showed uterine perforation located at the scar line of the previous uterine incision, through which omentum has entered the uterine cavity and traversed through the cervical canal into the vagina. That part of the omentum which had come into the uterine cavity was removed after ligating all feeding vessels, and the rest of the omentum was placed back into the peritoneal cavity. The uterus was preserved and the patient was discharged in stable condition. Uterine perforation sometimes may present with minimal symptoms and a thorough history and physical examination is key in diagnosing it. Unsafe abortions in hands of quacks and unqualified practitioners leading to life-threatening complications still remain a major problem in developing countries like India and require the immediate attention of policymakers.