Bowel perforation secondary to illegally induced abortion: a tertiary hospital experience in Tanzania

Abstract

BackgroundBowel perforation though rarely reported is a serious complication of induced abortion, which is often performed illegally by persons without any medical training in developing countries. A sudden increase in the number of patients in our centre in recent years prompted the authors to analyze this problem. The study was conducted to describe our own experiences in the surgical management of these patients.MethodsThis was a retrospective study involving patients who were jointly managed by the surgical and gynecological teams at Bugando Medical Centre (BMC) for bowel perforation secondary to illegally induced abortion from January 2002 to December 2011. The statistical analysis was performed using SPSS version 17.0.ResultsA total of 68 patients (representing 4.2% of cases) were enrolled in the study. Their ages ranged from 14 to 45 years with a median age of 21 years. Majority of patients were, secondary school students/leavers (70.6%), unmarried (88.2%), nulliparous (80.9%), unemployed (82.4%) and most of them were dependent member of the family. Previous history of contraceptive use was reported in only 14.7% of cases. The majority of patients (79.4%) had procured the abortion in the 2nd trimester. Dilatation and curettage (82.4%) was the most common reported method used in procuring abortion. The interval from termination of pregnancy to presentation in hospital ranged from 1 to 14 days (median 6 days ). The ileum (51.5%) and sigmoid colon (22.1%) was the most common portions of the bowel affected. Resection and anastomosis with uterine repair was the most common (86.8%) surgical procedure performed. Complication and mortality rates were 47.1% and 10.3% respectively. According to multivariate logistic regression analysis, gestational age at termination of pregnancy, delayed presentation, delayed surgical treatment and presence of complications were significantly associated with mortality (P<0.001). The overall median length of hospital stay (LOS) was 18 days (1day to 128 days ). Patients who developed complications stayed longer in the hospital, and this was statistically significant (P=0.012).ConclusionBowel perforation following illegally induced abortion is still rampant in our environment and constitutes significantly to high maternal morbidity and mortality. Early recognition of the diagnosis, aggressive resuscitation and early institution of surgical management is of paramount importance if morbidity and mortality associated with bowel perforation are to be avoided.

Etiology, treatment outcome and prognostic factors among patients with secondary peritonitis at Bugando Medical Centre, Mwanza, Tanzania

“…Moreover, secondary peritonitis is the commonest indication for admission in the surgical wards resulting into increased workload, increased duration of hospital stays, and complications such as enterocutaneous fistula, surgical site infections and sepsis. Furthermore, the death rates attributable to secondary peritonitis in this settings has been shown to be 10.7 % and 23.1 % among patients with peptic ulcer and typhoid perforations respectively [ 10 – 12 ]. Despite advances in surgical techniques, antimicrobial therapy, and intensive care support; the management of peritonitis continues to be highly demanding, difficult, and complex [ 3 , 13 ].…”

“…Previous studies from BMC were retrospective and each focused on single etiology thus, lacking a holistic approach in addressing the implicated etiologies [ 10 – 12 ]; therefore the present study aimed at exploring the wide range of etiologies causing secondary peritonitis so as to identify factors responsible for the poor outcome and specifically address them in the context of reducing poor outcomes among patients with secondary peritonitis.…”

Gangrenous Bowel Prolapse-Disaster of Dilatation and Curettage

“…In Augustin et al [9] reviews of D&C related bowel injury, 12 abortion-related intestinal prolapse were reported in 50 years and all of them had intestinal resection and anastomosis just as our patient did. Mabula et al [10] reported a sudden increase in bowel perforation from induced abortion in their centre, where dilatation and curettage was the commonest method used in 82% of their cases. Resection and anastomosis with uterine repair, as was offered to our patient, was the surgical procedure performed in 87% of their cases.…”

Intra-abdominal fetal head - a consequence of illegal abortion

“…India, showed that though the small intestines were most commonly involved however the mortality of large bowel injuries was higher. 5,6 Sooner the reparative surgery, better was the prognosis. 7 Commonly bowel perforation occurs when the posterior vaginal wall is violated, allowing the instrument to pierce the underlying structures.…”