title: Trophoblastic tissue spread to the sigmoid colon after uterine perforation.
abstract: BACKGROUND
  Trophoblastic tissue spread following uterine perforation during dilation and curettage is rare. We present a case of trophoblastic spread to the sigmoid colon following uterine perforation, which was treated by surgical removal of the implants and intramuscular administration of methotrexate.
  
  
  METHODS
  A woman presented 3 weeks after curettage for a blighted ovum. Laparotomy performed for suspected intra-abdominal bleeding revealed bleeding trophoblastic implants in a perforation tract and the anterior uterine wall and on the appendix epiploica of the sigmoid colon. The implants were surgically removed and methotrexate was administered for persistently high beta-hCG levels. The patient fully recovered.
  
  
  CONCLUSIONS
  Extrauterine trophoblastic implants should be considered in women evaluated for abdominal pain whose pregnancy test is positive after uterine perforation. Conservative treatment with methotrexate in nonacute patients may be considered.
authors.affiliation: The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. i-levin@barak-online.net
authors.forename: Ishai
authors.initials: I
authors.lastname: Levin
authors.forename: Dan
authors.initials: D
authors.lastname: Grisaru
authors.forename: David
authors.initials: D
authors.lastname: Pauzner
authors.forename: Benny
authors.initials: B
authors.lastname: Almog
mesh_terms: D000328:Adult; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004107:Dilatation and Curettage / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008727:Methotrexate / Q000627:therapeutic use; D009361:Neoplasm Invasiveness / Q000473:pathology*; D011247:Pregnancy; D018570:Risk Assessment; D012811:Sigmoid Neoplasms / Q000556:secondary* / Q000628:therapy; D016896:Treatment Outcome; D014328:Trophoblastic Neoplasms / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D014595:Uterine Perforation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery
chemical_list: D008727:Methotrexate