A rare presentation of Uterine perforation after Two days of Dilatation and Curettage procedure in a Scarred uterus with Extruded Fetal parts in abdominal cavity- Case Report

Abstract: - A life threatening complication of intrauterine procedure (Dilatation and curettage)is uterine perforation besides having medico legal implications. Since medical abortion has been legalized, it has become very rare during the D&C procedure in recent times. Early diagnosis is key to survival, especially if an unsafe abortion has been performed. Therefore, if the patient has lower abdominal pain, and the history of surgical abortion may be unknown most of the time, a high index of suspicion should be maintained. This case report emphasizes an atypical presentation of uterine perforation in a 28 year old woman with H/o Caesarean section 1 year back, who underwent D&C procedure at 19 weeks of pregnancy. She was discharged after the surgery, assuming there were no complications. Two days after the procedure, patient presented with complaints of acute abdominal pain and distension associated with features of internal bleeding and Bowel obstruction. Trans abdominal Ultrasound was performed, uterine perforation with Massive Haemoperitoneum was diagnosed. X ray abdomen erect view confirmed Bowel obstruction. Intra operatively, Fetal parts were removed from Pouch of Doughlas and abdominal cavity. Prompt recovery was achieved after surgical intervention. This case report highlights the importance of increased awareness during the D&C procedure. Furthermore, it also emphasizes the importance of pre-operative counselling and post-operative monitoring to ensure early detection and prompt management of life-threatening complications.