Evisceration trans vaginale suite a une perforation uterine par manoevre abortive: A propos d'un cas.

Les auteurs rapportent ici un cas de perforation uterine recu a la maternite du Centre Hospitalier et Universitaire (CHU) de Yaounde au Cameroun, perforation consecutive a des manipulations endo uterines a but abortif. Apres la procedure se sont installes un saignement vaginal abondant et une complication moins rencontree : l'evisceration des anses greles d'une longueur d'environ 50 cm par voie vaginale, suite certainement a la saisie de ces anses et a leur traction successive les ayant ramenes d'abord dans la cavite uterine, puis le vagin et enfin a la vulve. La prise en charge medico-chirurgicale a ete rapide. Apres une transfusion de 2 unites de sang et une triple antibioprophylaxie, une resection de l'anse grele avec anastomose terminoterminale a ete faite, de meme que le curetage de la cavite uterine a travers la breche de perforation qui a ete par la suite suturee .La patiente est sortie de l'hopital 12 jours apres la chirurgie. Ce cas met en exergue la clandestinite des avortements provoques qui sont responsables de complications multiples dont les plus redoutables sont les lisions viscerales apres perforation uterine. The authors report a case of uterine perforation managed at the maternity of the Yaounde University Teaching Hospital (Cameroon), following intra uterine manoeuvres for an abortion. After the procedure, there was heavy vaginal bleeding and a 50 cm small bowel evisceration through the vagina, which is a rare complication. The small intestines might have been pulled through the uterus, vagina and the vulva. After transfusion of 2 pints of blood and triple antibiotherapy, intestinal resection with an end-to-end anastomosis was done. Uterine revision was also done with a curette sent through the opening of the perforation. This was later closed and the patient discharged 12 days after surgery. This case illustrates the amplitude of clandestine abortions whose complications are multiple, the most serious of which are deep wounds of internal organs through the perforations. Keywords : Avortement provoque - Perforation uterine - Evisceration transvaginale. Clinics in Mother and Child Health Vol. 3(2) 2006: pp. 295-297