Bladder Rupture Following Surgical Mid-Trimester Abortion

Abstract

A 25 years 2nd gravida with previous normal vaginal delivery was admitted with complaints of excessive vaginal bleeding following surgical termination of pregnancy at 16 weeks of gestation at a private hospital. Clinical examination revealed mild abdominal distension and a bulky uterus with moderate amount of bleeding per vaginum.Emergency ultrasound showed bulky uterus wth an empty cavity and free fluid in abdomen and pelvis. Abdominal X-Ray (erect view) didn't reveal any bowel perforation. Perurethral catheterisation showed frank hematuria. Patient was prepared for emergency laparotomy with a provisional diagnosis of uterine perforation with bladder injury.Per operatively, hemoperitoneum of 1500 ml and uterus enlarged to 14 weeks size with a vertical rent of 6 cm in the anterior wall. Bladder examination revealed 10 cm full thickness tear at the roof and 5 cm partial thickness tear in the anterior wall. (Fig. 1) Bowel exploration revealed no injury. Both the uterine and bladder rents were repaired. Suprapubic cystotomy and per urethral catheterization were done. Check cystogram on 14 th post-operative day revealed right vesico-ureteric reflux with no bladder leak. (Fig. 2 Bladder rupture following perforation of the uterus in association with elective mid-trimester abortion is an uncommon, but potentially serious complication. Such lacerations not only increase the immediate post-abortal morbidity but may also adversely influence future reproductive performance. Uterine perforation rates are highest in teaching settings and in cases of advanced parity and gestation. 1The exact incidence of such complication is not known. Early result of follow up study by Mackay et al showed increased risk of perforation of the myometrium with general anesthesia was reversed.2 In a large first trimester NJOG 2012 Jan-June; 7(3): 64-65 letter to editor