Late Presentation of Unsafe Abortion after 5 Years of Procedure

A majority of the unsafe abortions are performed by untrained birth attendants or quacks leading to complications in a large proportion of these cases. Complications like bowel injury, bladder injury, uterine perforation, and septic abortion are mostly caused by unskilled hands and are detected immediately or within few days of the procedure, owing to the need for tertiary level care. Here we present a very interesting case of unsafe abortion induced by a Ryle’s tube in a 32-year-old lady, which was diagnosed five years after the procedure. Considering its atypical presentation, it is the first case of its kind in the literature. The details of the case and its management are described along with appropriate pictures. 1. Introduction World Health Organization (WHO) defines unsafe abortion as a procedure for terminating an unintended pregnancy either by individuals without the necessary skills or in an environment that does not conform to minimum medical standards or both [1]. In India, unsafe abortion is mostly carried out by untrained birth attendants or quacks. Lack of knowledge and requisite skill as well as disregard about asepsis results in various complications like sepsis, uterine perforation, bowel and bladder injury, and vesicovaginal fistula. These occur primarily due to usage of sharp instruments. Rarely, vesicovaginal fistula can also occur because of the use of some chemical substances for criminal abortion [2]. Rubber catheter has been widely used in India as an abortifacient, as mentioned in a case series of 200 midtrimester medical termination of pregnancies (MTPs) in the early eighties [3]. We report an interesting case where a 70？cm long Ryle’s tube was used for illegal abortion causing uterine perforation and partial extrusion of the tube into the peritoneal cavity. Surprisingly, there were no complaints from the patient until 5 years had passed. 2. Case Report A 32-year-old lady, P2L2A1, presented to our hospital with complaints of pain abdomen for the last two months and a foreign body protruding from the introitus for the last 15 days. Patient had earlier gone to a local hospital with complaints of continuous dull aching pain in the lower abdomen, wherein ultrasonography (USG) of abdomen and pelvis revealed a tubular and slender foreign body coiled up in the pelvis and probably in the uterine cavity. Attempts to remove the foreign body vaginally had failed there; hence, the patient was referred to our institute with the partially extruded foreign body hanging from the introitus. A detailed history was taken in our hospital. Her