Abstract
BackgroundInduced abortion, whether therapeutic or elective, is a surgical procedure frequently practiced worldwide. It is a significant cause of maternal morbidity and mortality. When the procedure is performed in precarious conditions, by unqualified personnel, it leads to serious consequences, including uterine perforation and its associated lesions. Its management remains a medico-surgical emergency.Case presentationWe present two cases of unsafe abortions performed by cervical dilatation and intrauterine curettage which resulted in uterine perforation and intestinal evisceration through the vagina leading to acute intestinal obstruction. Both patients underwent intensive resuscitation followed by an emergency laparotomy. The first case was a 26-year-old woman living in rural Cameroon. Following a procedure of termination of her pregnancy, the patient noted the presence of bowel at the vaginal introitus associated with signs of intestinal obstruction. She was transferred to a specialized center was after 4 days later of the onset of the evisceration. Considering the gangrened eviscerated terminal ileum, a right hemicolectomy with anastomosis was performed, as well as a suture of the uterine perforation. The second patient was an 18-year-old African living as a refugee in Cameroon. She was referred for abdominal pain in the context of intestinal obstruction with a viable jejunal loop extruding through the vagina. A simple jejunal resection was performed with end-to-end anastomosis and suture of the uterine perforation. In both cases, the postoperative course was uneventful.ConclusionsUterine perforation is a serious complication of intrauterine gynecological procedures and instrumental abortion in particular. It can lead to evisceration of the intra-abdominal viscera through the uterine perforation. It is therefore a real surgical emergency with multiple and fatal consequences.
Highlights
Induced abortion, whether therapeutic or elective, is a surgical procedure frequently practiced world‐ wide
Uterine perforation is a serious complication of intrauterine gynecological procedures and instrumen‐ tal abortion in particular
It can lead to evisceration of the intra-abdominal viscera through the uterine perforation
Summary
Unsafe abortion remains a public health significant concern in low-income countries in particular. It increases the risk of maternal morbidity and death through complications such as uterine perforation with intra-abdominal evisceration unto the perineum; septic shock, peritonitis, and multi-organ dysfunction. PNM: obtained the patient’s consent, collected the pictures and aided in acquisition of study for the literature review. Ethics approval and consent to participate As a case report, the study is exempt from ethical approval in my institution. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Author details 1 Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. 3 Department of Surgery, Faculty of Medicine and Bio‐ medical Sciences, University of Yaounde I, Yaounde, Cameroon
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