A rare complication of dilation and evacuation: Unrecognized extrauterine retained products of conception

Introduction: Surgical abortions, including dilation and evacuation, are among the safest gynecological procedures, with complication rates ranging from 0.5–4.0%. Uterine perforation, though rare (0.2–0.8%), can result in serious sequela, including translocation of retained products of conception into the abdominal cavity. We present a rare case of abdominal retained products of conception following a second-trimester dilation and evacuation. Case Report: A 29-year-old G3P1112 underwent an elective surgical abortion at 17 weeks’ gestation, complicated by hemorrhage necessitating transfer to an outside hospital. She was treated with uterotonics and a blood transfusion and was discharged after a 6-day hospitalization. Initial transvaginal ultrasound showed no intrauterine retained products of conception, though a right adnexal cyst was noted. Eight days later, she re-presented with similar symptoms. Abdominal imaging was suggestive of an intra-abdominal fetal skull. She was transferred to our facility for surgical evaluation. Exploratory laparoscopy identified a 4×4 cm inflammatory mass adherent to the uterine fundus and abdominal wall, containing purulent fluid and fetal calvarium. A mesenteric defect in the sigmoid colon suggested prior instrumentation injury, though the bowel lumen remained intact. The mass was excised, and pathology confirmed degenerative fetal tissue. The patient recovered well post-operatively. Conclusion: This case highlights the importance of confirming complete evacuation following a second-trimester surgical abortion and maintaining high clinical suspicion for extrauterine retained products of conception in patients with persistent symptoms, even in the absence of obvious intrauterine findings. Magnetic resonance imaging may be helpful in equivocal cases, and diagnostic laparoscopy should be considered when imaging and clinical presentation are inconclusive.