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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 157-158

Rubber catheter eroding into the pelvic bone: An unusual complication of unsafe abortion


Department of General Surgery, CMC, Ludhiana, Punjab, India

Date of Web Publication9-Apr-2018

Correspondence Address:
Renji Mathew
Department of Surgery, CMC, Ludhiana - 141 008, Punjab, India
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_75_16

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  Abstract 


A majority of unsafe abortions are performed by untrained quacks leading to multiple complications which contribute to significant maternal morbidity and mortality. We report an unusual and late complication of unsafe abortion, where a red rubber tube which was believed to be left in the patient's body during an abortion conducted at home about 1 year ago, later got extruded out of the patient's body, through abdomen and eroding the pelvic bone, but fortunately causing no damage to any abdominal organs.

Keywords: Adhesiolysis, laparoscopy, red rubber tube, unsafe abortion


How to cite this article:
Pawar P, Mathews A, Mathew R, Chaudhry NK, Verma H. Rubber catheter eroding into the pelvic bone: An unusual complication of unsafe abortion. CHRISMED J Health Res 2018;5:157-8

How to cite this URL:
Pawar P, Mathews A, Mathew R, Chaudhry NK, Verma H. Rubber catheter eroding into the pelvic bone: An unusual complication of unsafe abortion. CHRISMED J Health Res [serial online] 2018 [cited 2019 Mar 21];5:157-8. Available from: http://www.cjhr.org/text.asp?2018/5/2/157/229590




  Introduction Top


A majority of unsafe abortions are performed by untrained birth attendants leading to complications in a large number of cases. Usually, the complications are catastrophic and life-threatening. Complications such as bowel and bladder injury and sepsis present very early leading to the need for tertiary level care.[1] Sometimes, these procedures lead to rare complications as in the case presented here.


  Case Report Top


A 21-year-old female presented to casualty with a red rubber tube protruding from the skin over the left iliac crest for 1 month. She did not complain of any abdominal pain or bowel and bladder abnormalities. There was no history of vomiting or fever, and there was no discharge from the tube. There was no history of bleeding or discharge per vaginum or menstrual irregularities. On thorough questioning, she gave a history of having undergone an illegal abortion by a local “Dai” 1 year back.

Her examination was unremarkable with the exception of a rubber tube eroding through the left ilium bone just 5 cm inferior to the anterior superior iliac spine [Figure 1]. Her per vaginum and per speculum examination were unremarkable.
Figure 1: Patient presentation with foreign body seen protruding out of the abdomen below the level of iliac crest

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An abdominal radiograph revealed a radio-opaque tube coiled in the pelvis with one end eroding out of the left ilium. A computed tomography scan confirmed the position of the tube and excluded any bowel and bladder erosion [Figure 2]a and [Figure 2]b. There was no involvement of the uterus, and the tube was seen to be in the peritoneal cavity.
Figure 2: (a) X-ray pelvis anteroposterior showing the position of the tube. (b) Computed tomography scan showing cross sectional view. (c) Intra-operative picture showing the rubber tube with adhesions to bowel but not intruding it

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The patient was taken up for a laparoscopic removal of the foreign body. The tube was found to be densely adherent to the small bowel loops and lateral abdominal wall with no bowel and bladder perforation [Figure 2]c. The uterus was normal with no signs of perforation. A careful adhesiolysis was done, and tube was freed and taken out from the ilium bone. The bowel was inspected for any injuries, and a drain was placed in situ. A curettage of the ilium bone was performed and simultaneously hysteroscopy was done which was normal. The patient had an uneventful recovery and was discharged in a satisfactory condition.


  Discussion Top


The World Health Organization defines unsafe abortion as a procedure for terminating an unintended pregnancy either by individuals without the necessary skills or in an environment that does not conform to minimal medical standards or both.[2] This leads to severe health consequences ranging from visceral injury, genital injury to septicemia and death. An estimated 19 million unsafe abortions occur worldwide each year, resulting in the death of 70,000 women, contributing to 8.9% of maternal mortality.[3],[4] There are innumerable ways in which unsafe abortion can be conducted. Objects used for abortions are knitting needles, wooden or metal sticks, roots of plants, or even a bougie. The complications can manifest immediately or after a few days.[5]

In this case, however, the symptoms manifested after a year, and surprisingly, the typical features of an intra-abdominal or intrauterine foreign body were all absent. The patient had no menstrual irregularity, discharge per vaginum, chronic pelvic pain, subacute intestinal obstruction, vomiting, etc. A plausible explanation for this is the fact that the rubber tube is made of an inert material and the uterine perforation may have occurred through a less vascular portion of the uterine wall. Moreover, the earlier symptoms of pain or bleeding per vaginum could have been attributed to the abortion.[1]

This is the only reported case in which a rubber tube used for an unsafe abortion has migrated from the uterus to the peritoneal cavity and then eroded through the ilium bone externally. Unsafe abortions can lead to chronic complications which can present after a long time interval. Laparoscopic removal of the foreign body allowed minimal morbidity and quick recovery and is a good option to be considered for the abdominal foreign body.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nayak PK, Mitra S, Padma A, Agrawal S. Late presentation of unsafe abortion after 5 years of procedure. Case Rep Obstet Gynecol 2014;2014:456017.  Back to cited text no. 1
    
2.
World Health Organization. The prevention and management of unsafe abortion. Report of a Technical Working Group. Geneva: World Health Organization; 1992.  Back to cited text no. 2
    
3.
Grimes DA. Unsafe abortion: The silent scourge. Br Med Bull 2003;67:99-113.  Back to cited text no. 3
    
4.
Sample Registration Bulletin. Registrar General India, Vital Statistics Division, Ministry of Home affairs. Vol. 32. New Delhi; 1998.  Back to cited text no. 4
    
5.
Cisse CT, Faye EO, Cisse ML, Kouedou D, Diadhiou F. Uterine perforation after an illegal abortion. Med Trop (Mars) 1999;59:371-4.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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