Abstract
BackgroundAbnormal uterine anatomy, especially leiomyomas, can significantly impact the difficulty and potential morbidity of surgical uterine evacuation. To avoid hysterotomy and/or hysterectomy, limited evidence exists to guide surgical uterine evacuation when pregnancy tissue is inaccessible with routine instruments.Case presentationA 41-year-old G4P1021 African American woman at 14 4/7 weeks’ gestation was referred for surgical-induced abortion in the setting of an enlarged leiomyomatous uterus. Two large opposing leiomyomas at the internal cervical os rendered pregnancy tissue inaccessible with routine gynecologic surgical instruments. With ultrasound guidance, an endotracheal tube was connected to routine electric suction and utilized to complete uterine evacuation.ConclusionsWith distorted or markedly enlarged uterine anatomy rendering pregnancy tissue inaccessible with routine surgical instruments, the minimally invasive use of an endotracheal tube may aid completion of uterine evacuation for surgical uterine evacuation.
Highlights
Abnormal uterine anatomy, especially leiomyomas, can significantly impact the difficulty and potential morbidity of surgical uterine evacuation
Borgatta and Stubblefield suggest the use of other instruments to reach pregnancy tissue including nasogastric tubes, flexible cannulas telescoped through a rigid cannula, and endotracheal tubes (ETTs); no such reports exist in the published literature [7]
We present a case report using an ETT to complete surgicalinduced abortion
Summary
This case report presents the use of an ETT to aid in uterine evacuation when pregnancy tissue was inaccessible to routine gynecologic instruments in the setting of complex, enlarged leiomyomatous uterus. Invasive surgical techniques using novel instruments from other disciplines may be beneficial to increase a patient’s options and avoid the morbidity associated with more invasive surgical procedures
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