Uterine Perforation with Bowel Herniation and Gangrene following Manual Vacuum Aspiration: A Case Report

Uterine perforation is an uncommon but serious breach of the uterine wall, which may rarely progress to bowel herniation—a life-threatening condition where intestinal loops protrude into the uterine cavity or pelvis. It is primarily a gynecological problem that often requires the intervention of a general surgeon. Most cases are iatrogenic occurring during Intrauterine Device (IUD) insertion (forty to fifty percent of perforations), Dilation and Curettage (D&C), hysteroscopy, surgical abortions or endometrial biopsies. Rarely, spontaneous perforation may occur in uterine malignancies or postpartum uterine necrosis. Complications can include Bowel obstruction or ischemia (20% of cases), peritonitis, sepsis, fistula formation, hemorrhage or infertility from delayed diagnosis. Management entails aggressive resuscitation and Immediate laparotomy for bowel reduction/resection and uterine repair (primary closure/hysterectomy if necrotic) as may be indicated by the specific presentation. Antibiotics and hemodynamic support for septic complications. Report of uterine perforation with bowel herniation is rare especially in early pregnancy as in this index case. More so if the herniated bowel is gangrenous, hence the desire to present this rare occurrence.