Chronic uterine perforation

Our patient is a 30 yr old woman without any known disease. About 1 month ago she underwent dilatation & curettage (D & C) procedure for RPOC. The patient was referred to USG pelvis by the gynaecologist as patient is having intermittent pelvic pain.

Findings and discussion:

On TVS, uterus is anteverted with normal size, shape and endometrial echo however, there is hypoechoic tract is noted at the posterior uterine wall near fundus extending from the endometrial cavity up-to the serosal surface.  

On thorough scanning of adnexa:

Bilateral fallopian tubes appear dilated, tubular structure with contained product within showing low level echoes likely to represent hematosalpinx/ pyosalpinx.

Both ovaries seen adherent to uterus. There is no free sliding of ovaries seen s/o absent sliding sign.

So, the diagnosis of chronic uterine perforation is given.

Further the patient underwent HSG:

HSG showed bilateral hydrosalpinx with minimal peritoneal spillage of contrast.

At last patient was taken for Laparoscopy:

On laparoscopy, badly damaged bilateral fallopian tubes noted with multiple thick pelvic adhesions.

So, bilateral salpingectomy with adhesiolysis is performed.   

High index suspicion of uterine perforation should be there in post-operative cases ( D & C) , as it can cause life threating haemorrhagic shock and maternal mortality.