Uterine rupture after gunshot wound with protrusion of intact amniotic sac and fetal long bones

Introduction: Intrapartum gunshot wounds (GSWs) to the abdomen or pelvis can cause significant injury and mortality to pregnant persons and their fetuses. Rapid imaging and emergency laparotomy are often necessary for diagnosis and treatment. Case Report: A 14-year-old G0P0 patient at 18 weeks gestation presented status post GSW with imaging concerning for a ballistic-induced uterine rupture with fetal demise and hemoperitoneum. At the time of exploratory laparotomy, 500 cc of hemoperitoneum was noted with fetal long bones penetrating through a 5 cm rupture in the uterine wall. The amniotic sac remained intact. An en caul delivery of the fetus was performed as well as uterine curettage. Ballistic injury was noted to the left Fallopian tube and omentum. No other intra-abdominal injuries were noted. Postoperatively, the patient experienced no surgical complications and was discharged on postoperative day 10. Conclusion: This case highlights a unique complication of an intrapartum GSW leading to uterine rupture and fetal demise at 18 weeks.