Journal of Education and Teaching in Emergency Medicine

Uterine perforation is a rare but potentially life-threatening complication of gynecologic procedures. Seriouscomplications include hemorrhage, infection, and injury to surrounding organ systems (eg, gastrointestinal,urological, vascular, etc.). Risk factors include advanced maternal age, prior gynecologic surgeries, and otheranatomical features that impact the difficulty of accessing the uterine cavity. In this case report, we discussa patient who presented to the emergency department (ED) with diffuse abdominal pain and vaginal bleedingthat occurred after an elective dilation and curettage (D&C) for a termination of pregnancy. The diagnosiswas suspected clinically and confirmed by imaging including ultrasound (US) and computed tomography (CT)of the abdomen and pelvis. The patient was managed operatively with a multidisciplinary approach includingGynecology, General Surgery, and Urology. The patient was stabilized and eventually discharged. Uterineperforation should be included in the differential for patients with a history of recent gynecologicinstrumentation presenting with abdominal pain and vaginal bleeding. The stabilization of these patientsrequires aggressive volume resuscitation, controlling the source of bleeding, and emergent surgicalconsultation.