Intra-Abdominal Retained Products of Conception: A Rare Complication Postsurgical Abortion by Dilation and Evacuation

Abstract

Background:

Uterine perforation is one of the most-serious complications after a surgical abortion, and the risk of such perforation is increased in second-trimester procedures. When a uterine perforation occurs, products of conception (PoC) can migrate through the uterine defect to the abdominal cavity requiring surgery for their extraction.

Case:

In a 17-year-old patient, intra-abdominal fetal remains were caused by multiple uterine perforations following a dilation and evacuation procedure for a surgical abortion at 19 weeks' gestation. An emergency laparotomy was required to control this patient's bleeding, repair the uterine perforations, and extract the fetal remains. Fetal reconstruction from extracted fragments was incomplete, and, despite performing an extensive review of the abdominal cavity and an intraoperative radiography that did not identify fetal structures, a postoperative computed tomography scan showed fetal remains in the left parietocolic region. A diagnostic laparoscopy was performed for their extraction during the same hospitalization.

Results:

After the extraction, the patient recovered well.

Conclusions:

Intra-abdominal retained PoC must be considered after a surgical abortion complicated with uterine perforation, especially if fetal reconstruction of the extracted fragments is incomplete and no intrauterine fetal remains are identified by ultrasound. (J GYNECOL SURG 37:263)