title: Incarcerated small bowel associated with elective abortion uterine perforation.
abstract: BACKGROUND
  Uterine perforation is a rare but recognized complication of abortion. Perforations may not be recognized at the time of the procedure, and patients may present days or weeks later with sequelae of the complication.
  
  
  OBJECTIVE
  To raise awareness of this rare complication that can present days to weeks after the precipitating event.
  
  
  METHODS
  A 21-year-old woman presented 3 weeks after an elective abortion with symptoms of bowel obstruction. Exploratory laparotomy revealed small bowel herniation into a perforated uterus, causing the obstruction. In retrospect, a pre-operative ultrasound and computed tomography (CT) scan suggested this finding, but it went unrecognized at that time. A small bowel resection was performed and the patient made an uneventful recovery.
  
  
  CONCLUSIONS
  Intrauterine bowel after abortion has been described only a handful of times in the literature. Uterine perforation during abortion is usually asymptomatic and generally can be managed conservatively, but herniation of bowel through the uterine defect can result in obstruction and strangulation. Intrauterine bowel requires prompt laparotomy and possible resection of non-viable bowel. Although ultrasound and CT scans may aid in diagnosis of this rare complication, a clinical suspicion for uterine perforation should be maintained by health care providers when treating patients who have had an abortion.
authors.affiliation: Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Coughlin
authors.forename: Dorothy A
authors.initials: DA
authors.lastname: Sparks
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Chase
authors.forename: James
authors.initials: J
authors.lastname: Smith
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects*; D004107:Dilatation and Curettage / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D005260:Female; D006547:Hernia / Q000150:complications*; D059685:Herniorrhaphy; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007813:Laparotomy; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D014057:Tomography, X-Ray Computed; D014595:Uterine Perforation / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology*; D055815:Young Adult