Small Bowel Perforation Caused by Uterine Iatrogenic Perforation Secondary to Endometrial Curettage: A Report of a Rare Case

This report describes a rare case of small bowel perforation associated with iatrogenic uterine perforation during endometrial curettage, which was successfully treated despite delayed diagnosis. A 62-year-old patient, in septic condition and exhibiting symptoms of acute abdomen, was admitted to our hospital five days after undergoing diagnostic endometrial curettage due to postmenopausal metrorrhagia. Inflammatory markers were elevated. An emergency computed tomography (CT) scan revealed the presence of pneumoperitoneum and multiple fluid collections with air-fluid levels throughout the peritoneal cavity. Emergency laparotomy was performed, with severe fecal peritonitis secondary to small bowel perforation being observed. No primary uterine perforation site was confirmed intra-operatively, although histological examination of the endometrial curettage material confirmed the presence of smooth muscle tissue and debris of intestinal epithelium. Salvage surgery for neglected peritonitis was carried out, including enterectomy that involved the perforation site and creation of two ileostomies (end ileostomy and mucus fistula). The patient's worsening condition prompted admission to the intensive care unit (ICU), where she remained for 22 days and was subsequently transferred to the surgical ward, where she remained for another 15 days. She was discharged from the ward in good condition with instructions for follow-up assessment and scheduling of bowel restoration surgery. Based on the description of this rare case, the diagnostic approach and therapeutic options for this rare complication are discussed. Special emphasis is placed on the benefits of early diagnosis, which significantly contributes to ensuring the best prognostic outcome.