Cases reported "Uterine Perforation"

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1/26. uterine perforation resulting in bowel infarction: sharp traumatic bowel and mesenteric injury at the time of pregnancy termination.

    BACKGROUND: By law, elective terminations of pregnancy are not performed in U.S. military institutions. However, in the civilian sector, more than a million abortions are performed each year, some of which are on military beneficiaries. Although complications are relatively rare, patients not uncommonly present for follow-up care to their military installation. We report the case of a patient who presented after a second-trimester elective abortion and was found to have suffered uterine perforation with mesenteric and bowel injury that required bowel resection. CASE: An 18-year-old gravida 1 para 0 female presented from an outlying facility 1 week after elective termination at 18 weeks of gestation with complaints of severe abdominal pain, nausea, and vomiting. Exploratory laparotomy for presumed bowel obstruction revealed uterine perforation and bowel devitalization and necrosis, which required small bowel resection. Fetal bones were discovered within the surgical specimen. CONCLUSION: Morbid, even potentially fatal, complications can occur as a result of pregnancy termination. With second-trimester procedures, perforation can result in injury to abdominal viscera from the perforating instruments or even from sharp fetal bony structures. Military gynecologic surgeons, who are not in abortion practice, must nevertheless be cognizant of the potential for perforation leading to serious visceral injury.
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ranking = 1
keywords = pregnancy, gestation
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2/26. Placenta increta/percreta associated with uterine perforation during therapy for fetal death. A case report.

    BACKGROUND: placenta accreta involves abnormal adherence of the placenta to the myometrium. Placenta increta and percreta are defined by the degree of trophoblastic penetration of the myometrium. These conditions are rarely observed in the first trimester; placenta increta and percreta are exceptionally infrequent. CASE: A woman had a uterine perforation after suction curettage for fetal death at 11 weeks' gestation, requiring hysterectomy for control of a profuse hemorrhage. Histopathologic examination of the uterus revealed placenta increta involving the lower uterine segment and placenta percreta at the site of uterine perforation. CONCLUSION: This is the first report of placenta percreta associated with uterine perforation during therapy for first-trimester fetal death.
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ranking = 0.053047264402776
keywords = gestation
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3/26. Spontaneous uterine perforation mimicking ectopic pregnancy as the initial presentation of placental site trophoblastic tumor.

    Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease (GTD), with only 100 cases reported in the literature. Irregular vaginal bleeding has been reported to be the most common presenting symptom, however, spontaneous uterine perforation, mimicking ectopic pregnancy, as the initial presentation is extremely rare, and has not yet been reported in the Chinese literature. Herein, we report a 26-year-old female with PSTT complicating with uterine perforation that mimicked ectopic pregnancy as the initial presentation. She received wide excision of the uterine perforation margin only and now remains disease-free, 2 years after the operation. Reviewing the literature, while most cases of PSTT behave a benign fashion, some exhibit malignant behavior; surgery remains the mainstay of therapy. For patients whose disease is limited to the uterus, simple total abdominal hysterectomy is the treatment of choice. For patients with extensive or metastatic disease, cytoreductive surgery (total abdominal hysterectomy and resection of extrauterine tumor load) combined with chemotherapy should be applied. etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA/CO) chemotherapy appears superior to other available chemotherapeutic regimens in the treatment
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ranking = 1
keywords = pregnancy, gestation
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4/26. Entrapment of viable trophoblastic tissue in a uterine hematoma after surgical evacuation. A case report.

    BACKGROUND: Postevacuation uterine perforation is a common event. early diagnosis and management are important to minimize the associated morbidity and mortality. CASE: A woman presented with persistent vaginal bleeding for two weeks following surgical uterine evacuation for missed abortion at 7 weeks' gestation. She had a persistently elevated serum human chorionic gonadotropin level. ultrasonography revealed a 3-cm, heterogeneous mass with high vascularity at the left anterior uterine fundal region; the endometrial echo was normal. Cornual pregnancy was suspected, and surgical resection was planned. Intraoperatively, a uterine hematoma with evidence of previous uterine perforation was diagnosed. hysterotomy, removal of the hematoma and repair of the uterus were performed. Histologic examination revealed entrapment of trophoblastic tissue in the specimen. The patient had an uneventful recovery. CONCLUSION: Entrapment of trophoblastic tissue in a uterine hematoma is a rare sequel of uterine perforation after evacuation and might be confused with cornual pregnancy.
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ranking = 0.36869817626852
keywords = pregnancy, gestation
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5/26. Spontaneous uterine rupture with amniotic sac protrusion at 28 weeks subsequent to previous hysteroscopic metroplasty.

    BACKGROUND: Hysteroscopic metroplasty improves pregnancy outcome in case of uterine septum. uterine rupture during a pregnancy following this procedure may occur. CASE: A patient with a history of hysteroscopic resection of a uterine septum complicated by fundal perforation, presented at 28 weeks a spontaneous uterine rupture with amniotic sac protrusion through the uterine wall disruption. CONCLUSION: uterine rupture during pregnancy following a hysteroscopic metroplasty may occur even though it appears to be a very uncommon event. patients who have had this procedure should be aware of this potential risk in case of future pregnancies. How to avoid such complication is still unclear.
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ranking = 0.47347636779861
keywords = pregnancy
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6/26. Large uterine defect found at cesarean section. A case report.

    BACKGROUND: Uncomplicated uterine perforation has been considered a benign event. Since the advent of operative hysteroscopy, there have been several reports of uterine rupture during pregnancy in patients who have undergone that procedure when complicated by known or unsuspected uterine perforation. Large fundal defects without rupture have also been reported. CASE: A 23-year-old, white woman was admitted for labor induction at 42 weeks' gestation. After an unsuccessful attempt at labor induction, a cesarean section (C/S) was performed. At that time a large (5-cm) fundal defect was noted. A thorough history suggested that the defect was probably the result of unsuspected perforation of the uterus during dilatation and currettage for a late first-trimester fetal death. A follow-up hysterosalpingogram was done and consultation obtained regarding future management. A course of expectant management with C/S prior to the onset of labor was advised. Three years later, after an uncomplicated pregnancy, a repeat C/S was done at 38 weeks' gestation. CONCLUSION: patients with a history of operative hysteroscopy or difficult curettage may have sustained known or unsuspected perforations of the uterus with subsequent scarring or defect, placing them at some risk of uterine rupture during pregnancy. patients should be counseled regarding these risks, and assessment by hysterography might be helpful.
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ranking = 0.57957089660416
keywords = pregnancy, gestation
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7/26. Sonographic diagnosis of a uterine defect in a pregnancy at 6 weeks' gestation with a history of curettage.

    We present the early diagnosis and successful surgical treatment of uterine perforation. This was a rare case of cystic change of a uterine perforation, which was diagnosed by sonography during the first trimester of pregnancy. Surgical closure of the uterine wall defect was successful.
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ranking = 1.0013163372755
keywords = pregnancy, gestation
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8/26. Management of a perforated levonorgestrel-medicated intrauterine device--a pharmacokinetic study: case report.

    Intrauterine contraception is a widely used, highly effective method of birth control. uterine perforation is a serious albeit rare complication with the use of an intrauterine device (IUD). Although uterine perforation by the levonorgestrel-releasing intrauterine system (LNG-IUS) has already been described, no plasma LNG concentrations in this setting were reported. Neither has the management of LNG-IUS been commented on to date. Two months after insertion of an LNG-IUS into a 33-year-old woman, it was noted to be in the peritoneal cavity. laparoscopy for IUD removal was conducted 5 months after insertion. LNG and sex hormone-binding globulin plasma concentrations were measured prior to and following the laparoscopic removal of the IUD. Intra-peritoneal dislocated LNG-IUS resulted in plasma LNG levels 10 times higher (4.7 nmol/l) than the plasma level of LNG observed with LNG-IUS placed in utero. This high plasma LNG level suppresses ovulation. Therefore a misplaced LNG-IUS should be removed when pregnancy is desired.
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ranking = 0.15782545593287
keywords = pregnancy
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9/26. Placenta increta complicating a first-trimester abortion. A case report.

    Placenta increta complicating pregnancy in the first trimester is rare. A patient with risk factors for placenta increta required a hysterectomy to control a hemorrhage after a first-trimester abortion. Pathologic study confirmed the preoperative diagnosis of placenta increta.
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ranking = 0.15782545593287
keywords = pregnancy
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10/26. Migration of an intrauterine contraceptive device to the sigmoid colon: a case report.

    BACKGROUND: copper T intrauterine devices (IUDs) remain the mainstay of family planning measures in developing countries, but have been associated with serious complications such as bleeding, perforation and migration to adjacent organs or omentum. Although perforation of the uterus by an IUD is not uncommon, migration to the sigmoid colon is extremely rare. Here, we report a case of migration of an IUD to the sigmoid colon. CASE REPORT: A 40-year-old woman who had an IUD (copper T), inserted 1 month after delivery, presented, 7 months later, with secondary amenorrhea and transient pelvic cramps. Clinical findings and ultrasonographic examinations of the patient revealed an 8-week pregnancy, while laboratory tests were normal. Transvaginal ultrasonography also visualized the IUD located outside the uterus, near the sigmoid colon, as if it were attached to the bowel. The pregnancy was terminated at the patient's wish; a diagnostic laparoscopy was performed concomitantly, which showed bowel perforation owing to the migration of the IUD. The device, which was partially embedded in the sigmoid colon, was removed via laparoscopy; however, because of bowel perforation, laparotomy was performed to open colostomy. CONCLUSIONS: This case report highlights the continuing need for intra- and postinsertion vigilance, since even recent advances in IUD technique and technology do not guarantee risk-free insertion.
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ranking = 0.31565091186574
keywords = pregnancy
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