Abstract：
OBJECTIVE: Operative hysteroscopy is a common gynecologic procedure, but it carries the risk of complications. Spontaneous small intestine perforation is rare and fatal, especially in young adults. We present a spontaneous small intestine perforation after operative hysteroscopy with mimicking sign of uterine perforation after operation hysteroscopy.
METHODS: A 30-year-old nulligravida woman underwent Truclear® hysteroscopic polypectomy in the morning in LMD. She suffered from upper abdominal pain in the afternoon. Subsequently, progressive abdominal distention and imminent shock occurred the next morning. Initially, it was supposed to be a case of uterine rupture with internal bleeding. She was transferred to the emergency department of our hospital. Complete biochemistry data and abdominal CT were performed. The CT revealed pneumoperitoneum and ascites. Emergent laparoscopy was arranged. The abdominal cavity was full of intestinal fluid and the myomatous uterus was intact. The surgeon performed a laparotomy, two sites of spontaneous perforation of the small intestine were detected. The patient underwent laparotomic segmental resection and anastomosis and was discharged 14 days after surgery without incident.
CONCLUSIONS: The risk of uterine perforation during hysteroscopy is up to 1.6%. The use of non-thermal intrauterine morcellator device (Truclear®) has been shown to significantly reduce the risk of perforation and thermal injury. As this case highlights, we suspected the possibility of uterine perforation immediately after hysteroscopic surgery. However, it happened to be rare spontaneous perforation of small bowel. The patient recovered well after timely transfer and management. Hysteroscopy is a very common procedure in gynecologic clinics, but even relatively safe intrauterine morcellator devices carry risk of complications. As a healthcare provider, we should beware of any comorbidity, for sometimes it would be catastrophic.
METHODS: A 30-year-old nulligravida woman underwent Truclear® hysteroscopic polypectomy in the morning in LMD. She suffered from upper abdominal pain in the afternoon. Subsequently, progressive abdominal distention and imminent shock occurred the next morning. Initially, it was supposed to be a case of uterine rupture with internal bleeding. She was transferred to the emergency department of our hospital. Complete biochemistry data and abdominal CT were performed. The CT revealed pneumoperitoneum and ascites. Emergent laparoscopy was arranged. The abdominal cavity was full of intestinal fluid and the myomatous uterus was intact. The surgeon performed a laparotomy, two sites of spontaneous perforation of the small intestine were detected. The patient underwent laparotomic segmental resection and anastomosis and was discharged 14 days after surgery without incident.
CONCLUSIONS: The risk of uterine perforation during hysteroscopy is up to 1.6%. The use of non-thermal intrauterine morcellator device (Truclear®) has been shown to significantly reduce the risk of perforation and thermal injury. As this case highlights, we suspected the possibility of uterine perforation immediately after hysteroscopic surgery. However, it happened to be rare spontaneous perforation of small bowel. The patient recovered well after timely transfer and management. Hysteroscopy is a very common procedure in gynecologic clinics, but even relatively safe intrauterine morcellator devices carry risk of complications. As a healthcare provider, we should beware of any comorbidity, for sometimes it would be catastrophic.
摘要：
目的：宫腔镜手术是一种常见的妇科手术，但它有并发症的风险。自发性小肠穿孔罕见且致命，尤其是年轻人。我们提出了宫腔镜手术后自发性小肠穿孔，模仿宫腔镜手术后子宫穿孔的迹象。
方法：一名30岁的未妊娠妇女在LMD的早晨接受了Truclear®宫腔镜息肉切除术。她下午上腹痛。随后，第二天早上发生进行性腹胀和即将发生的休克。最初，应该是子宫破裂内出血。她被转移到我们医院的急诊科。进行完整的生物化学数据和腹部CT。CT提示气腹和腹水。安排紧急腹腔镜检查。腹腔充满肠液，肌瘤子宫完整。外科医生做了剖腹手术,检测到两个自发性小肠穿孔部位.该患者接受了腹腔镜节段切除和吻合术，并在手术后14天出院，无事故。
结论：宫腔镜检查期间子宫穿孔的风险高达1.6%。非热子宫内粉碎器装置（Truclear®）的使用已被证明可以显着降低穿孔和热损伤的风险。正如这个案例所强调的，我们怀疑宫腔镜手术后子宫穿孔的可能性。然而,它恰好是罕见的自发性小肠穿孔。患者经及时转运和管理后恢复良好。宫腔镜检查是妇科诊所中非常常见的手术，但即使是相对安全的宫内粉碎装置也有并发症的风险。作为医疗保健提供者，我们应该提防任何合并症，因为有时会是灾难性的。
方法：一名30岁的未妊娠妇女在LMD的早晨接受了Truclear®宫腔镜息肉切除术。她下午上腹痛。随后，第二天早上发生进行性腹胀和即将发生的休克。最初，应该是子宫破裂内出血。她被转移到我们医院的急诊科。进行完整的生物化学数据和腹部CT。CT提示气腹和腹水。安排紧急腹腔镜检查。腹腔充满肠液，肌瘤子宫完整。外科医生做了剖腹手术,检测到两个自发性小肠穿孔部位.该患者接受了腹腔镜节段切除和吻合术，并在手术后14天出院，无事故。
结论：宫腔镜检查期间子宫穿孔的风险高达1.6%。非热子宫内粉碎器装置（Truclear®）的使用已被证明可以显着降低穿孔和热损伤的风险。正如这个案例所强调的，我们怀疑宫腔镜手术后子宫穿孔的可能性。然而,它恰好是罕见的自发性小肠穿孔。患者经及时转运和管理后恢复良好。宫腔镜检查是妇科诊所中非常常见的手术，但即使是相对安全的宫内粉碎装置也有并发症的风险。作为医疗保健提供者，我们应该提防任何合并症，因为有时会是灾难性的。
