Epidemiology and management of intra-abdominal injuries due to criminal abortion

ABSTRACT

To collect data about different aspects of epidemiology of intra-abdominal injuries due to criminal abortions and devise a plan of management for various categories of intra-abdominal injuries. This observational case series study was carried out in Surgical unit 2, Bahawal Victoria hospital, Bahawalpur, from January 2006 to December 2007. A total of 40 consecutive patients were studied. All patients of abdominal injuries due to criminal abortion were included in the study. Patients of criminal abortion having only gynaecological complications i.e. per vaginal bleeding, septicaemia and acute renal failure were excluded from the study and only the patients with abdominal injuries were included. Relevant history and appropriate physical examination was performed and necessary investigations were done. Exploratory laparotomy was performed and injuries were treated accordingly. The most common age group developing intra-abdominal injury due to criminal abortion was of 25-34 years [77.5%]. Most of these abortions were in first trimester [70%], in women belonging to poor socio-economic status [80%]. Sixty five percent of these abortions were induced by semi-skilled persons, mostly by dilatation and curettage [70%]. The most common clinical presentation was painful abdominal distention [57.5%]. On laparotomy, gut injury was found in 20 [50%] cases, out of which 12 [60%] cases underwent gut exteriorisation. Isolated uterine injury was observed in 13 [32%] cases, out of which 12 [92%] patients underwent primary uterine repair. Intra-abdominal injuries due to criminal abortions are a definite entity. They usually present as acute abdomen. Exploratory laparotorny is mandatory; viscera most commonly injured are gut and uterus