Uterine perforation with omentum incarceration after dilatation and evacuation/curettage: magnetic resonance imaging findings

Abstract

To our knowledge, this is the first report wherein MRI was used for the detection of incarcerated omental fat within the uterus. Delayed presentation of uterine perforation may be observed 1 month or more after D/E&C, although such a finding is extremely rare. Therefore, postabortal follow-up bimanual vaginal examination using transvaginal ultrasonography is recommended. The current study indicates the usefulness of MRI when myometrial perforation with or without incarceration of an extrauterine organ is suspected.

Omental Incarceration over Twenty Years Presenting as a Hyperechoic Endometrial Mass in a Postmenopausal Woman

“…Uterine perforation after D&C is usually diagnosed immediately after or several days after the D&C and a delayed presentation is extremely rare. There is a case of uterine perforation diagnosed at 28 days after the D&C and the patient complained lower abdominal pain and small amount of vaginal bleeding [ 7 ]. However, some cases of uterine perforation can be asymptomatic for the minimal accompanying bleeding or no injuries to adjacent organs.…”

“…In terms of omental incarceration after D&C, symptomatic cases have been reported and presented with abdominal pain, vaginal bleeding or discharge [ 7 8 9 10 ]. All cases were reported in premenopausal women and this is the first report on omental incarceration in postmenopausal women with the longest duration of asymptomatic period.…”

Hysteroscopic management of omentum incarceration secondary to uterine perforation: Case report and review of literature

“…In our case, a high‐resolution ultrasound, performed by an expert, revealed the presence of omentum inside the uterus, described as a hyperecogenic structure with continuity towards the abdominal cavity, and ruled out bowel incarceration. Magnetic resonance may help to confirm the diagnosis as well as hysteroscopy 6 . Bowel injury or incarceration can go unnoticed for several hours, but such injuries should be suspected if a patient presents abdominal distension, persistent abdominal pain or signs of peritonitis and should be evaluated by a general surgeon.…”

Response to ‘Silent uterine rupture occluded by intestinal adhesions following laparoscopic myomectomy: A case report’: Do some remain permanently silent?

“…In the case described by Kuwata et al , intestinal adhesion might have masked the symptoms and signs and delayed the diagnosis . In another reported case, the incarcerated omentum occluded the uterine perforation after surgery in a patient who underwent dilatation and evacuation/curettage . In that case, the occlusion masked the perforation, as well as the usual symptoms and signs.…”