A case report and review of the literature of bowel entrapment through uterine perforation following manual vacuum aspiration as a rare cause of small bowel obstruction

Introduction and importance: Uterine perforation is an uncommon but serious complication of manual vacuum aspiration (MVA) and may result in bowel evisceration, incarceration, ischemia, and intestinal obstruction. This case concerns acute small-bowel obstruction caused by small-bowel entrapment through a uterine perforation following MVA for abortion. It is reported in accordance with the SCARE criteria. Case presentation: A 29-year-old woman, gravida four para 3 + 1, at 13 weeks’ gestation presented with a 4-day history of worsening generalized colicky abdominal pain, bilious vomiting with feculent material, absolute constipation, fever, and intermittent vaginal bleeding following MVA. Emergency exploratory laparotomy revealed a septic, perforated uterus with a 2 cm posterior wall perforation through which a 25 cm segment of gangrenous ileum was entrapped. The affected ileum was resected and primarily anastomosed, followed by a total abdominal hysterectomy and peritoneal lavage. Clinical discussion: Small bowel obstruction secondary to bowel entrapment through uterine perforation following MVA is rarely reported in the literature. Conclusion: Small bowel obstruction secondary to bowel entrapment through a uterine perforation following MVA is an exceptionally rare but life-threatening complication. Early recognition, prompt imaging, and timely surgical intervention are crucial to prevent bowel ischemia, sepsis, and maternal morbidity.