Abortion induced by a foreign body with artificial perforation of the uterus, followed by sepsis, coma, necrosis of the uterus and hysterectomy. A case report.

摘要

Case study An 18-year-old woman was brought into the emergency room of a national hospital in Dili, East Timor, with GCS 5, fever of 39.5degC, blood pressure of 80/50 mmHg and pulse of 130 per minute. There were only few anamnestic data. She had fallen into coma three days before and was treated with unknown intravenous drugs in a hospital in a remote province. On admission, treatment with quinine for suspected cerebral malaria was commenced. On gynaecological examination, only mild peritoneal signs in the hypogastric regions and an offensive smell from the vagina were present; the vaginal fornices and cervix were necrotic. A 4-cm-long twig from a bush was found in her vagina. An ultrasound examination showed normal size uterus with blurred anterior wall and a small amount of free fluid around the uterus. A perforated uterus was suspected. The family did not consent to the surgery and the patient remained comatosed. Antibiotics (ampicilin, metronidazole, gentamycin), intravenous fluids and antipyretics were started. After 12 h in the intensive care unit, the patient recovered from the coma (GCS 14), but remained febrile, oliguric, with blood pressure of 100/60 mmHg, heart rate of 90 per minute, and haemoglobin of 85 g/L; malaria slide was negative. No other laboratory investigation was possible.