title: Laparoscopic Removal of an Intramyometrial Fetus After Uterine Curettage.
abstract: OBJECTIVE
  To show the removal of an intramyometrial fetus after uterine curettage using laparoscopy as a safe surgical technique that offers excellent results and fewer complications than laparotomy.
  
  
  METHODS
  Presentation of the clinical case and step-by-step explanation of the technique.
  
  
  METHODS
  Uterine curettage is a frequently performed gynecologic abortion procedure. Dilatation and curettage is considered to be a safe surgical technique, with a low percentage of complications. The most common is uterine perforation, with higher risks in advanced gestational age, retroflexed uterus, or uterine leiomyomas.
  
  
  METHODS
  After institutional review board approval, we present the case of a 29-year-old women referred to our hospital from another clinic with a suspected uterine perforation after an elective curettage for a 14-week pregnancy. She presented with moderate abdominal pain. Vaginal ultrasound revealed intramyometrial fetal parts on isthmus and right parametrium and minimal free fluid in the pouch of Douglas. A laparoscopic approach was chosen. After a complete revision of the abdominal cavity, the right paravesical space was dissected, confirming no right uterine artery or ureter injury. One cavity was objectified in the posterior leaf of the broad ligament related to a uterine perforation and containing fetal bone parts, which were removed. The myometrial defect and the peritoneum were closed with intracorporeal sutures. The removal of fetal parts was done with a surgical glove thimble. After the procedure, the patient was treated with clindamycin and gentamycin, with a satisfactory recovery.
  
  
  CONCLUSIONS
  The presence of an intramyometrial fetus is not a common complication of curettage. The use of laparoscopy is feasible and offers excellent results and advantages versus laparotomy regarding its treatment.
authors.affiliation: Department of Gynecological Oncology, "Hospital Universitario la Paz", Madrid, Spain. Electronic address: ptobiasg@gmail.com.
authors.forename: Pablo
authors.initials: P
authors.lastname: Tobías González
authors.affiliation: Department of Gynecological Oncology, "Hospital Universitario la Paz", Madrid, Spain.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Mateos Guillem
authors.affiliation: Department of Gynecological Oncology, "Hospital Universitario la Paz", Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Zapardiel
authors.affiliation: Department of Gynecological Oncology, "Hospital Universitario la Paz", Madrid, Spain.
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Diestro
authors.affiliation: Department of Gynecological Oncology, "Hospital Universitario la Paz", Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: De Santiago
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects; D000328:Adult; D003475:Curettage / Q000009:adverse effects; D004107:Dilatation and Curettage / Q000009:adverse effects*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000193:education*; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy / Q000009:adverse effects; D011247:Pregnancy; D014621:Vagina / Q000601:surgery