Laparoscopic Management of Uterine Perforation with Incarceration of the Fallopian Tube

Background: Dilation and curettage (D&C) is a safe, common surgical procedure. Complications occur rarely, but outcomes depend upon prompt recognition and management of such complications. Acute abdominal pain after D&C, even without a suspicion of hemorrhage, warrants additional evaluation. Case: A 36-year-old gravida 5, para 2022, woman underwent a suction D&C in early pregnancy and, postoperatively, had significant pain symptoms and signs of an acute abdomen. Diagnostic laparoscopy revealed an incarcerated, transected fallopian tube drawn into the endometrial cavity through a small uterine perforation. The incarcerated fallopian tube was released from the myometrial defect, and salpingectomy was performed. Results: The patient was discharged to go home on the day of surgery, and her recovery was unremarkable. Conclusions: Uterine perforation during D&C might involve adnexal structures or the surrounding viscera. This case report is the first report of immediate laparoscopic management of fallopian-tube incarceration after uterine perforation. Laparoscopy is the preferred approach for a patient with suspected uterine perforation who is hemodynamically stable.