BOWEL INJURIES FOLLOWING UNSAFE ABORTION: THE SURGEON’S PERSPECTIVE

OBJECTIVE: To study the pattern of bowel injuries in patient with unsafe abortion, 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%) 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.