September 2016 · Volume 5 · Issue 9 Page 3223 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Ramola M et al. Int J Reprod Contracept Obstet Gynecol. 2016 Sept;5(9):3223-3225 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Case Report Bowel injury: a rare but dreaded complication of unsafe abortion Monika Ramola 1 *, Priyanka Chaudhari 1 , Parul Singh 2 , Mahesh Ramola 3 INTRODUCTION Unsafe abortion is one of the most neglected sexual and reproductive health problems in India. It is defined as an induced abortion process conducted either by unskilled personnel or performed in anon accreidated facility. 1 The most common reasons for induced abortion are unwanted pregnancy, health problems, want of a male child, economic, social or family problems that forced the women to seek abortion. Bowel perforation is a rare but serious complication of induced abortion. These injuries often go unnoticed and unrecognized by the unqualified person further delaying their proper management, hence leading to catastrophic morbid situation to the mother. CASE REPORT A 29 year old woman P2L2 with history of previous 2 LSCS presented to the emergency with complains of fever off and on, lower abdominal pain and abdominal distension of five days duration. After about 48 hrs, she noticed passage of loose stools from the vagina two to three times per day. She underwent termination of pregnancy twice at a peripheral private centre for? Three and a half months amenorrhea. No documented record of the procedure was traceable. First procedure was ten days back following which she complained of persistent vaginal bleeding for which she consulted same private centre and then again underwent same procedure after five days which lead to complications. On examination at our centre, she was conscious, oriented, febrile, pulse rate was 100/min and BP was 100/60 mm Hg. Per abdominal examination, showed that abdomen is distended and there was generalized tenderness, guarding and rigidity. Bowel sounds were sluggish. Per speculum examination revealed stools coming out through the cervical os, vaginal walls were intact. On per vaginal examination uterine size could not be accessed because of tenderness. After proper work up and routine investigations including CT scan, patient was taken for laparotomy .Per op findings revealed, a rent of the size 3x3 cm in the fundus of the uterus through which ileum was seen going into the cavity as shown in Figure 1. On removing the bowel from the uterine rent, the bowel segment was found to be gangrenous. Proximal bowel was distended uptil the ileum as shown in Figure 2. Thorough lavage was done and gangrenous segment was resected and a double barrel ileostomy was performed. Uterine rent was repaired in two layers with vicryl no 1 and check curettage was done through the rent. Patient was discharged in stable 1 Department of Obstetrics and Gynaecology, SGRRIMHS, Dehradun, Uttarakhand, India 2 Department of Obstetrics and Gynaecology, PGIMS, Rohtak, Haryana, India 3 Department of Surgery, SGRRIMHS, Dehradun, Uttarakhand, India Received: 01 July 2016 Accepted: 05 August 2016 *Correspondence: Dr. Monika Ramola, E-mail: dr.monika.ms@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Unsafe abortions represent a preventable yet major cause of maternal mortality and morbidity in India. Intestinal perforation is a rare dreaded complication of unsafe abortion. It is commonly seen in countries in which abortions are performed by people without proper training and proper instruments. Bowel perforation occurs when the posterior vaginal wall or the uterine wall is perforated. The ileum and the sigmoid colon are the most commonly injured portion of the bowel. Here, we report a case of ileal perforation following induced unsafe abortion which was managed successfully. Keywords: Bowel injury, Unsafe abortions DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20163019