Coughlin, L. Incarcerated small bowel associated with elective abortion uterine perforation. Journal of Emergency Medicine , 44 3 , e Crosfill, F. Ultrasound scan appearance of perforated uterus after surgical evacuation of retained products of conception. Journal of Obstetrics and Gynaecology, 26 3 , —9. Darney, P. Uterine perforation during second-trimester abortion by cervical dilation and instrumental extraction: A review of 15 cases. Freiman, S. Management of uterine perforation following elective abortion.
Gakhal, M. Sonographic diagnosis of extruded fetal parts from uterine perforation in the retroperitoneal pelvis after termination of intrauterine pregnancy that were occult on magnetic resonance imaging. Journal of Ultrasound in Medicine 28 12 —7. Grimes, D. The Journal of the American Medical Association, 27; 16 , — Unsafe abortion: the preventable pandemic. The Lancet, , Goldschmit, R. Management of uterine perforation complicating first-trimester termination of pregnancy. Israel Journal of Medical Sciences , 4 , Kaali, S.
The frequency and management of uterine perforations during first trimester abortions. Kerns, J. Management of postabortion hemorrhage. Contraception , 87 3 , Kumar, P. Laparoscopy as a diagnostic and therapeutic technique in uterine perforations during first trimester abortions. Asia — Oceania Journal of Obstetrics and Gynaecology , 14 1 , 55—9. Lauersen, N. The laparoscopic inspection revealed massive adhesions of the transverse colon and greater omentum to the anterior abdominal wall, including formation of several adhesion bands, which were related to the previous abdominal surgeries.
The bladder, bowel, and uterine vessels were intact, and the uterine perforation was confirmed. Consequently, further actions were not necessary and the postoperative patient recovery was satisfactory Fig. Nine weeks after curettage, a control hysteroscopy, adhesiolysis of the preexisting abdominal adhesions, and a laparoscopically assisted vaginal hysterectomy with bilateral salpingoophorectomy, because of an endometrial adenocarcinoma, were performed following the German guidelines.
The uterine cavity exhibited multiple endometrial polyps, few synechias, and a completely healed wall. A total of 1. The pelvic organs were free of adhesions, and the uterine wall completely uneventful; the area of former perforation was prominent with the shiny surface of normal peritoneum. Despite the region having sustained a bleeding injury, there was no adhesion formation Fig.
Additionally, a 0. There were no intra or postoperative complications. Our patient received no adjuvant therapy. The area of the former uterine perforation is completely healed without adhesion formation, but is more prominent black arrow. There is a 0. When this powder is directly applied onto the bleeding surface, it builds a tight viscous mesh of gel and blood components comparable to that of a native coagulum, and is capable of sealing bleeding areas.
Since the postoperative diagnosis of endometrial carcinoma necessitated subsequent surgery, the outcome of this polysaccharide could be evaluated 9 weeks later. This is, to the best of our knowledge, the first report on the use of this substance to control the bleeding after a uterine perforation.
Perforation of the uterus is the most common complication of curettage and may result in several problems, including bleeding, damage to viscera, and peritonitis [ 1 — 3 ], requiring a fast damage control.
Furthermore, hematoma formation and any kind of peritoneal trauma due to coagulation or suture of the uterine wall might result in adhesion formation with pathologic sequelae, such as chronic pain, secondary infertility, or acute ileus [ 8 , 9 , 15 ].
Nine weeks after the treatment, a subsequent hysteroscopy and a radical hysterectomy by laparoscopy was performed because of an endometrial carcinoma, allowing the assessment of the outcome of the product. It was observed that the wound had healed satisfactorily with a normal appearance of the uterine wall and serosa, without adhesions around the uterus or pelvic organs.
This single case cannot be a formal proof of the efficacy of the mentioned novel hemostatic and anti-adhesion agent, but may contribute to its relevant evidence. Accordingly, based on the dual action of this powder, combining a hemostatic and adhesion prevention effect, this novel product can be considered in the treatment of limited injuries of the uterine wall.
Of course, further studies are necessary to establish the superiority of this product over other alternatives in the treatment of limited injuries of the uterus. Complications of hysteroscopy: a prospective, multicenter study. Obstet Gynecol. Complications in hysteroscopy surgery. In: Complications in gynecological surgery. ISBN Chapter Google Scholar.
Munro M, Christianson LA. Complications of hysteroscopic and uterine resectoscopic surgery. Clin Obstet Gynecol. Article PubMed Google Scholar. A multicenter survey of complications associated with operative hysteroscopies. General complications of operative hysteroscopy: management and prevention. Operative hysteroscopy: a practical guide.
Google Scholar. Peritoneal repair and post-surgical adhesion formation. Hum Reprod Update. Adhesions are the major cause of complications in operative gynecology.
A review of the problematic adhesion prophylaxis in gynecological surgery. Arch Gynecol Obstet. Adhesions after abdominal, pelvic and intra-uterine surgery and their prevention. Thank you for updating your details. Log In. Sign Up. Become a Gold Supporter and see no ads. Log in Sign up.
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