Transvaginal sonographic findings of a large intramural uterine hematoma associated with iatrogenic injury sustained at termination of pregnancy

Abstract

CASE REPORTA 21-year-old woman, gravida 1 para 0, presented to the emergency room at State University of New York, Downstate Medical Center with right lower abdominal pain radiating to her back, and nausea and vomiting, 3 days after surgical termination of pregnancy at 14 weeks' gestation. Her medical history was unremarkable. The patient denied a history of sexually transmitted disease, and her recent cervical cytology was normal. Three days before presentation the patient had undergone an elective outpatient termination of pregnancy by dilatation and suction curettage. The presence of a 14-week intrauterine gestation had been confirmed by ultrasound scan before the procedure. The preoperative ultrasound examination did not reveal any abnormal uterine findings, including any evidence of uterine leiomyomata. The patient had been told that the procedure, which was not performed under real-time ultrasound guidance, was uneventful. She was given routine oral antibiotics (doxycycline 100 mg twice daily for 5 days and methergine 0.2 mg twice daily for 2 days). An immediate postprocedure ultrasound examination was not obtained following the termination of pregnancy.Physical examination on presentation revealed a healthy woman. She was afebrile, with blood pressure 103/66 mmHg, and pulse 82 beats per min. Her abdomen was soft, yet with marked tenderness of the lower abdomen but no signs of peritoneal irritation. Bimanual pelvic examination disclosed a soft tender uterus enlarged to 8 weeks' size. Both adnexa were normal. The cervix was long and closed yet motion tenderness was present. Laboratory results revealed a hemoglobin level of 10.3 g/dL, hematocrit 29.9%, a white blood cell count of 9.64 × 10 9 d/L and a platelet count of 227 × 10 9 d/L. Serum creatinine, blood urea nitrogen, electrolyte levels, prothrombin time and partial thromboplastin time were normal, and the serum betahuman chorionic gonadotropin (beta-hCG) level was 5651 mIU/mL. Transvaginal ultrasonography showed an acutely retroflexed uterus with a normal endometrial echo. Both adnexa were normal. No free fluid was noted in the cul-de-sac. A 5 × 5-cm, well circumscribed mass with a hypoechoic center was noted in the anterior aspect of the lower uterine segment (Figure 1). Color Doppler imaging

Sonographic and magnetic resonance imaging findings of pelvic abscess following uterine perforation sustained during office endometrial sampling

“…6,7 Systematic English literature search (PubMed, MEDLINE) between 1966 and 2010 utilizing the search terms ''endometrial biopsy,'' ''pelvic abscess,'' and ''ultrasound'' reveals that this is the first report of sonographic findings of a pelvic abscess complicating office endometrial biopsy.…”

Small Bowel Prolapse a Rare Complication Following Unsafe Abortion

“…When the patient presents with non-specific symptoms like abdominal distension, abdominal X-ray can show air-fluid levels of small bowel to point towards obstruction. Ultrasound examination showing free fluid in pelvis and loops of intestine within the endometrial cavity can clinch the diagnosis of bowel involvement [11]. Computed tomography scan can also help in diagnosing bowel loops within the endometrial cavity when ultrasound report is ambiguous.…”

“…The most critical factor in the prevention of this condition is the identification of patients who are at high risk of perforation. D&C should always be done under ultrasonographic guidance whenever available [11,12]. Early diagnosis, prompt resuscitation and treatment can prevent peritonitis, septic shock or any other severe complications to the patient.…”

Incarcerated Omentum With Tamponade Effect in the Uterine Perforation Scar After Dilation and Curettage: A Case Report

“…Sonography may sometimes be able to demonstrate the site of uterine rupture as a hypoechoic or anechoic transmural defect in myometrium extending to endometrium with presence of extrauterine fluid [2]. Usage of high resolution transvaginal probes can enhance the detection of perforation defects and mural hematomas [7]. CT has also been used for diagnostic evaluations of uterine perforations in few instances [8].…”