Acute abdomen a complication of uterine intervention

ABSTRACT

A prospective evaluation of 19 patients of complicated abortion presenting in the general surgical emergency over a period of four and a half years is presented. The mean age of the patients was 25.4 years. Presenting complaints included acute abdominal pain, vomiting, abdominal distension and absolute constipation in all cases. 16 patients were married and 3 unmarried. Tachycardia, pyrexia, generalised abdominal tenderness, guarding and absent bowel sound were present in all cases. Free gas under the diaphragm was present in 11 patients and multiple air fluid level in 8 patients. 13 out of 19 patients had intestinal injury [10 small gut and 3 colon]. 7 patients had external evidence of intestinal injury. Fundus of the uterus and posterior fornix were the common sites of perforations. Fundal perforations were repaired. Hysterectomy was carried out when the perforation involved the fornixes and major vessels and in those patients who pre-operatively asked for it. In six patients resection and anastomosis for small gut injury was carried out where as in four patients perforations were repaired. In 3 patients with colonic injury, resections and anastomosis of the injured colon along with transverse colostomy were carried out. There were two deaths in this series. The incidence of post operative complications was low. Mean hospital stay remained 8 days. Emergency surgeon dealing with general surgical emergencies should keep this possibility in mind if patient gives history of D and C and features of acute abdomen