Laparoscopic reduction of strangulated small bowel incarceration by controlled enlargement of a uterine perforation following manual vacuum aspiration

Rezumat

Abstract Manual vacuum aspiration (MVA) is widely used for early pregnancy loss, but uterine perforation may cause serious intra-abdominal complications. Bowel incarceration through a uterine perforation can be difficult to recognize because clinical manifestations may be nonspecific. A 37-year-old woman underwent MVA for missed miscarriage at 6 weeks of gestation. After unsuccessful repeat suction for presumed intrauterine hematoma, she developed abdominal pain and vomiting. Contrast-enhanced computed tomography (CT) revealed small bowel herniation through a posterior uterine wall defect with reduced enhancement, suggesting strangulation. Emergency laparoscopy confirmed bowel incarceration. Controlled enlargement of the uterine defect enabled atraumatic bowel reduction; ischemic intestine was resected, and the uterus was repaired laparoscopically. This case demonstrates that bowel incarceration may present with mild findings despite ischemia and highlights the importance of prompt CT and avoidance of repeated intrauterine instrumentation when uterine perforation is suspected.