Uterine perforation

Introduction Uterine perforation (gynecology) refers to the full thickness of the uterine wall caused by intrauterine surgery, causing the uterine cavity to communicate with the abdominal cavity, or other organs. Uterine perforation is most common in female genital tract injuries. Can be seen in the placement or removal of intrauterine devices, induced abortion, mid-term induction of labor, diagnosis and scraping, etc., probes, cervical dilators, straws, curettes, placenta pliers or fingers can cause perforation. Perforation can occur in the fundus, isthmus or cervical canal, of which the most common is found in the isthmus. Can also penetrate into the broad ligament, the posterior wall of the bladder, intestinal fistula, and even pull out the omentum, leading to internal hemorrhage, hematoma in the broad ligament and secondary peritonitis. It must be diagnosed in time to avoid serious consequences.

Cause

Uterine perforation (gynecology) refers to the full thickness of the uterine wall caused by intrauterine surgery, causing the uterine cavity to communicate with the abdominal cavity, or other organs. Most of these gynecological emergencies occur in abortion errors, intrauterine devices, and diagnostic curettage. Due to inadvertent operation, holes in the myometrium are formed and communicate with the membrane cavity. Individual patients can occur in spontaneous rupture perforation of hydatidiform mole and chorionic epithelial cancer.

an examination

Related inspection

Hysteroscopic tiger red plate agglutination test

1. Sudden abdominal pain occurs during intrauterine surgery.

2. It is found that the depth of the device used to enter the uterine cavity is significantly higher than the estimated depth of the uterine cavity at the time of examination, and there is no resistance, and the resistance of the uterine wall is not felt.

3. Lower abdominal tenderness and rebound tenderness.

4. If the perforation damages the large blood vessels, there is a typical manifestation of internal bleeding in a short period of time, and shock occurs rapidly.

5. Palace side mass: If you penetrate the broad ligament injury blood vessels from the uterine isthmus, you can form a hematoma in the broad ligament.

Differential diagnosis

Differential diagnosis of uterine perforation:

Uterine perforation needs to be differentiated from hemorrhagic salpingitis. The main points of identification are: hemorrhagic salpingitis has a history of uterine unclean operation or a history of unclean sex, and the sputum puncture draws a light red liquid, usually with fever, and the onset is relatively slow. . The patient did not indicate whether or not there was fever, and no fever or body temperature should be considered.

Uterine perforation also requires attention to distinguish from uterine rupture:

Uterine rupture: The uterus or lower part of the uterus ruptures during the third trimester of pregnancy and during childbirth, known as uterine rupture. Before the uterine rupture, the patient's uterus contraction is frequent and intense. When the uterus is contracted, the uterus is gourd-like, and the lower segment is obviously bulged, with obvious tenderness, and dysuria or hematuria. If the uterus ruptures, it will save you a lot of time.

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