STUDY OBJECTIVE: To present and discuss the hysteroscopic aspects of incarcerated omentum through uterine perforation caused by previous dilatation and curettage (D&C) for incomplete first-trimester abortion.
DESIGN: Case report.
SETTING: Constantine University Hospital, Constantine, Algeria.
PATIENT: A 40-year-old, G3P2 patient, with a history of an incomplete first-trimester spontaneous abortion, treated 6 months before by D&C, requiring medical assistance due to moderate, chronic pelvic pain. No other clinical or biological alteration was found. The ultrasound showed intracavitary hyperechogenic formation, infiltrating the myometrium posteriorly.
INTERVENTION: Hysteroscopy revealed a fat-like lesion, arousing suspicion of residual trophoblast while differential diagnosis included intramyometrial fat metaplasia as well. A mechanical cold loop resection was initiated. Instrumental manipulation of the mass released yellow drops, probably of lipid nature, subsequently leading to the discovery of an uterine perforation, giving passage to omentum. Histological examination confirmed fat tissue. There was immediate resolution of symptoms. Laparoscopic repair was subsequently performed and consisted of suturing the defect. There were no further complications.
MAIN RESULT: Few cases of omentum incarceration in perforated uterus, diagnosed during laparotomy or by magnetic resonance, have previously been reported. To our knowledge, this is the first case revealed through hysteroscopy.
CONCLUSION: In women with a history of intracavitary interventions such as D&C, omentum incarceration should be considered when hysteroscopy demonstrates a fat-like formation and yellow droplets released by pressing or mobilizing the formation. Surgeons should be cautious, never using electrosurgery on formations whose origin arouses suspicion.
- omentum incarceration
- uterine perforation