Background: Manual intrauterine aspiration (MIUA) is widely used for uterine evacuation but may lead to severe complications, including uterine perforation. We report two cases illustrating diagnostic challenges and surgical management in a low-resource setting. Methods: Two patients presenting with intestinal complications following MIUA were evaluated clinically and surgically at the El Hadj Ibrahima Niass Regional Hospital Center. Results: Both cases involved delayed diagnosis of uterine perforation with small-bowel involvement. One patient underwent conservative uterine repair, while the second required hysterectomy and bowel resection. Both recovered favorably following timely surgical intervention. Conclusion: Uterine perforation after MIUA can be life-threatening. Early recognition, adequate provider training, and prompt surgical management are essential to improving outcomes, especially in resource-limited settings.
References
[1]
Chung, T.K.H., Cheung, L.P., Sahota, D.S., Haines, C.J. and Chang, A.M.Z. (1998) Spontaneous Abortion: Short‐Term Complications Following Either Conservative or Surgical Management. Australian and New Zealand Journal of Obstetrics and Gynaecology, 38, 61-64. https://doi.org/10.1111/j.1479-828x.1998.tb02960.x
[2]
Nielsen, S. and Hahlin, M. (1995) Expectant Management of First-Trimester Spontaneous Abortion. The Lancet, 345, 84-85. https://doi.org/10.1016/s0140-6736(95)90060-8
[3]
Cissé, C.T., et al. (1999) Perforation utérine après avortement clandestin. MédecineTropicale, 59, 371-374.
[4]
Bechem, E., Leopold, D. and Ako, T.W. (2016) Small Bowel Exteriorisation after Uterine Perforation from Manual Vacuum Aspiration for Abortion in a Young Cameroonian: A Case Report. Pan African Medical Journal, 25, Article No. 198. https://doi.org/10.11604/pamj.2016.25.198.10006
[5]
Coughlin, L.M., Sparks, D.A., Chase, D.M. and Smith, J. (2013) Incarcerated Small Bowel Associated with Elective Abortion Uterine Perforation. The Journal of Emergency Medicine, 44, e303-e306. https://doi.org/10.1016/j.jemermed.2012.02.071
[6]
Grossman, D., Blanchard, K. and Blumenthal, P. (2008) Complications after Second Trimester Surgical and Medical Abortion. Reproductive Health Matters, 16, 173-182. https://doi.org/10.1016/s0968-8080(08)31379-2
[7]
Mittal, S. and Misra, S.L. (1985) Uterine Perforation Following Medical Termination of Pregnancy by Vacuum Aspiration. International Journal of Gynecology & Obstetrics, 23, 45-50. https://doi.org/10.1016/0020-7292(85)90010-4
[8]
Ka, I., Saloum, P., Niang, A.B., Faye, A., Ndoye, J.M. and Fall, B. (2016) Péritonite aigue généralisée par perforation utérine post abortum à propos d’une observation. Pan African Medical Journal, 24, Article No. 98. https://doi.org/10.11604/pamj.2016.24.98.9307
[9]
Lauersen, N.H. and Birnbaum, S. (1973) Laparoscopy as a Diagnostic and Therapeutic Technique in Uterine Perforations during First-Trimester Abortions. American Journal of Obstetrics and Gynecology, 117, 522-526. https://doi.org/10.1016/0002-9378(73)90114-2
[10]
Amarin, Z.O. and Badria, L.F. (2004) A Survey of Uterine Perforation Following Dilatation and Curettage or Evacuation of Retained Products of Conception. Archives of Gynecology and Obstetrics, 271, 203-206. https://doi.org/10.1007/s00404-003-0592-8
[11]
Hilal, G.F., et al. (2014) A Serious Complication of Clandestine Induced Abortions: Septic Shock Secondary to Peritonitis by Cecal Perforation with Retention of Instruments. Revue Anesthésie-RéanimationMédecined’Urgence, 19, 87-92.
[12]
Thonneau, P.F. and Almont, T.E. (2008) Complications of Abortion Performed under Unsafe Conditions. Best Practice & Research Clinical Obstetrics & Gynaecology, 22, 323-332.
[13]
Kaali, S.G., Szigetvari, I.A. and Bartfai, G.S. (1989) The Frequency and Management of Uterine Perforations during First-Trimester Abortions. American Journal of Obstetrics and Gynecology, 161, 406-408. https://doi.org/10.1016/0002-9378(89)90532-2
[14]
Kerimis, P., Zolti, M., Sinwany, G., Mashiach, S. and Carp, H. (2002) Uterine Rupture after Hysteroscopic Resection of Uterine Septum. Fertility and Sterility, 77, 618-620. https://doi.org/10.1016/s0015-0282(01)03222-8
[15]
Fenomanana, M.S., et al. (2009) Profil épidémiologique et thérapeutique des pelvipéritonites post-abortives à la maternité du CHU d’Antananarivo (Madagascar). Revue d’anesthésie-Réanimation et de MédecineD’urgence, 1, 17-20.
