BOWEL INJURIES FOLLOWING UNSAFE ABORTION: THE SURGEON’S PERSPECTIVE
Article Sidebar
Main Article Content
Abstract
Objectives: To study the pattern of bowel injuries in patient with unsafe abortion, and its management and outcome.
Methodology: This retrospective study was conducted from July 2010 to July 2013, on patients attended by Surgical Unit III, at Department of Gynecology and obstetrics, Civil Hospital, Karachi. Twelve patients with bowel injuries following unsafe abortion were included. Relevant clinical data including demographic details, visceral injury, procedure performed, complications and mortality was collected and analysed on SPSS 17.
Results: Mean age was 27.6±6.1 years and 6 (50%) of patients were in age group 21-30 years. All patients presented during 1st trimester of pregnancy. Abdominal pain (91.7%) and fever (91.7%) were the commonest clinical presentations. Exploratory laparotomies were performed in all the patients. In six (50%) patients abdominal cavity was heavily contaminated with purulent discharge, necrotic and feculent material. Recto-sigmoid perforation (41.7%) and ileal perforation (33.3%) were the most common gut injuries. Uterine perforation was posterior in 58.3% cases. Hartmann’s procedure (41.7%) and resection & anastomosis (25%) were the common surgical procedures performed for different bowel injuries. Surgical site infections (66.7%) & respiratory tract infection (25%) were the most common postoperative complications. The overall length of hospital stay ranged from 3-28 days. Mortality rate was 8.3% (n=1).
Conclusion: Our results show a different pattern of injury to bowel and recto-sigmoid & ileal regions are the most commonly injured segments of bowel in patient with unsafe abortion. Bowel injury in patient with unsafe abortion has significant morbidity and mortality in our set up.
Article Details
Work published in KMUJ is licensed under a
Creative Commons Attribution-NonCommercial 2.0 Generic License.
Authors are permitted and encouraged to post their work online
(e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
References
Sedgh G, Henshaw S, Singh S, Ahman E, Shah IH. Induced abortion: Estimated rates and trends worldwide. Lancet. 2007; 370(95):1338 –45.
Bernstein PS, Rosenfield A. Abortion and maternal death. Int J Gynecol Obstet 1998;63:115- 22.
Sathar ZA, Singh S, Fikree FF. Estimating the incidence of abortion in Pakistan, studies in family planning. 2007;38(1):11–22.
Sherigar JM, Dalal AD, Patel J. Uterine Perforation with subtotal small bowel prolapse – A rare complication of dilatation and curettage. Online J Health Allied Scs 2005;1:6.
Bhutta SZ, Aziz S, Korejo R. Surgical complications following unsafe abortion. J Pak Med Assoc 2003;53:286-9.
Rehman A, Fatima S, Gangat S, Ahmed A, Memon IA, Soomro N. Bowel injuries secondary to induced abortion: a dilemma. Pak J Surg 2007;23:122–5.
Naib JM, Siddiqui MI, Afridi B. A review of septic induced abortion cases in one year at Khyber teaching hospital, Peshawar. J Ayub Med Coll Abbottabad 2004; 16(3):59–62.
Fawad A, Naz H, Khan K, Aziz-un-Nisa. Septic induced abortions. J Ayub Med Coll Abbottabad 2008; 20(4):145-8.
Siddiq MN, Ghazi A, Saddique M, Ali T, Jabbar S. Complications and management of unsafe abortion. .J Surg Pak 2008;13(1):12-5.
Rahim N, Ara A. Reasons due to which, women resort to illegally induced abortions. J Postgrad Med Inst 2008;22(4):309-12.
Shah N, Hossain N, Noorani M, Khan NH. Maternal mortality and morbidity of unsafe abortion in a university teaching hospital of Karachi, Pakistan. J Pak Med Assoc 2011; 61(6):582-6.
Mabula JB, Chalya PL, McHembe MD, Kihunrwa A, Massinde A, Chandika AB, et al. Bowel perforation secondary to illegally induced abortion: a tertiary hospital experience in Tanzania. World J Emerg Surg 2012;7(1):29.
Gupta S, Banerjee K, Bhardwaj DN, Dogra TD. Maternal death and induced abortion- A critical analysis. J Fam Wel 2000;46(1):57-60.
Oludiran OO, Okonofua FE: Morbidity and mortality from Bowel Injury secondary to Induced Abortion. Afr J Reprod Health 2003;7(3):65–8.
Justesen A, Kapiga SH, van Asten HA. Abortions in a hospital setting: hidden realities in Dar es Salaam, Tanzania. Stud Fam Plann. 1992; 2:325–9.
Rana A, Pradhan N, Gurung G, Singh M. Induced septic abortion: a major factor in maternal mortality and morbidity. J Obstet Gynaecol Res 2004;30(1):3-8.
Megafu U. Bowel injury in septic abortion: the need for more aggressive management. Int J Gynaecol Obstet 1980;17(5):450-3.
Jhobta RS, Attri AK, Jhobta A. Bowel injury following induced abortion. Int J Gynaecol Obstet 2007;96(1):24-7.
Imoedemhe DA, Ezimokhai M, Okpere EE, Aboh IF. Intestinal injuries following induced abortion. Int J Gynaecol Obstet 1984;22(4):303-6.
Shaikh Z, Abbassi RM, Rizwan N, Abbasi S. Morbidity and mortality due to unsafe abortion in Pakistan. Int J Gynae Obs 2010; 110(1):47-9.
Badakali MA, Kalburgi E b, Goudar BV, Pujari LL. Entero-uterine Fistula. A rare complication of an unsafe abortion. Jour Clini Diag Res 2012; 6(7): 1301-2 .
Nkor SK, Igberase GO, Osime OC, Faleyimu BL, Babalola R. Small bowel obstruction following perforation of the uterus at induced abortion. West Afr J Med 2009;28(5):337-9.
Coffman S. Bowel injury as a complication of induced abortion: a case report and literature review. Am J Surg 2001; 67(10):924-6.
Ntia IO, Ekele BA. Bowel prolapse through perforated uterus following induced abortion. West Afr J Med 2000; 19(3):209-11.
Dossou FM, Hounkpe PC, Bagnan JAT, Denakpo J, Sohou P. Small bowel prolapsed through perforated uterus following illegal induced abortion. Surg Curr Res 2012;2(4):118.
Nanda S, Sangwan K, Agarwal U. The ugly face of septic abortion. Eur J Obstet Gynecol Reprod Biol 2002;105(1):71-2.
Lebeau R, Guie P, Bohoussou E, Akpa-Bedi ES, Loukou Y, Kouassi JC, et al. An uncommon complication of unsafe induced abortion: Bowel prolapse through uterine perforation. Gyne Obs Fertil 2013; 41(3):193-5.