Sonohysterography in a suspected case of uterine perforation after dilatation and curettage for retained placenta

Abstract

Abstract A 35-year-old woman, gravida 3, para 2, spontaneously delivered an infant without any major complications. On the 38th day after delivery, she returned to the hospital due to irregular bleeding. Transvaginal ultrasound showed a mass in the cervix; therefore, dilatation and curettage was performed, using placental forceps, to remove the retained placenta. During the procedure, a uterine perforation was suspected. Sonohysterography was performed in order to confirm the uterine perforation. The sonohysterogram revealed that the high echogenic mass that was suspected to be retained placenta was adhered on the posterior uterine myometrium. Saline that had been injected into the uterine cavity escaped into the Douglas pouch via a small hole in the posterior uterine wall. An emergency laparotomy was performed. Pathological examination of the removed uterus revealed placenta increta in the posterior wall, as well as an adjacent perforated fistula. Sonohysterographic diagnosis of uterine perforation in the present case was not only validated with diagnosis, but also the residual placenta was clearly visible. The use of sonohysterography for detection of a suspected case of uterine perforation after dilatation and curettage was accurate and provided a safe procedure for fast evaluation.