ACUTE UTERINE PERFORATION
Our patient is a 30-year-old woman without any known disease. Recently she underwent dilatation & curettage (D & C) procedure for RPOC. She was referred to us for USG pelvis by the gynaecologist I/V/O lower abdominal pain.
Findings and discussion:
On TVS , uterus is retroverted with normal size , shape and endometrial echo however, there is hyperechoic tract is noted at the anterior uterine wall in the lower segment.
The hyperechoic tract is seen communicating with the peritoneal cavity.
There is no evidence of localized collection at present.
The tract is showing mild vascularity on Color Doppler.
On thorough scanning of adnexa:
Both ovaries and adnexa appear unremarkable at present scan without any evidence of localized collection.
So, the diagnosis of Acute uterine perforation is given.
It is mandatory to accurately diagnose uterine rupture as early as possible , as it can cause haemorrhagic shock and maternal mortality.
Uterine perforation represents a serious complication that can occur as a result of any type of intrauterine procedure.
No other complications noted on follow up ultrasounds.
Iatrogenic Uterine Perforation: Ultrasound Findings and Diagnosis
Iatrogenic uterine perforation occurs when a medical procedure unintentionally causes a hole in the uterine wall. It can happen during procedures such as dilation and curettage (D&C), hysteroscopy, intrauterine device (IUD) insertion, or endometrial biopsy.
Ultrasound Findings in Uterine Perforation
Ultrasound, particularly transvaginal ultrasound (TVS), is a key tool in diagnosing uterine perforation. The findings depend on the severity and associated complications.
1. Direct Signs
- Defect in the myometrium: A visible discontinuity in the uterine wall.
- Echogenic linear tract: Suggests the passage of an instrument through the uterus.
- Free-floating IUD: If the perforation occurred during IUD insertion, the device may be found outside the endometrial cavity.
2. Indirect Signs
- Fluid in the peritoneal cavity: Suggests bleeding or rupture.
- Hematoma near the uterus: If significant bleeding occurs.
- Echogenic foci in the myometrium or parametrium: May indicate retained surgical material or gas due to infection.
- Doppler Ultrasound Findings: Increased vascularity may suggest active bleeding, while absent flow may indicate necrosis or a sealed perforation.
Complications Detected on USG
- Hemoperitoneum: If significant internal bleeding occurs.
- Bowel or bladder injury: If perforation extends to adjacent organs.
- Pelvic abscess: If infection occurs post-perforation.
Management
- Mild Cases: Conservative management with observation, antibiotics if needed.
- Severe Cases: Laparoscopic or surgical repair if there’s ongoing bleeding or organ damage.
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