Delayed presentation of uterine perforation.

A 30-year-old woman presented to the emergency department with nonspecific abdominal pain 17 days after voluntary vacuum aspiration interruption of a first-trimester pregnancy. Physical examination and laboratory evaluation demonstrated mild diffuse abdominal tenderness without peritoneal signs and a mildly increased WBC count, respectively. When the patient's condition failed to improve she was admitted, and exploratory laparotomy was performed 5 days later. It revealed two uterine perforations, one of which contained incarcerated omentum with associated ischemic small bowel and complete small-bowel obstruction. Although uterine perforation with intraabdominal injury is a well-described complication of vacuum aspiration termination of pregnancy, most postabortion perforations go undetected. Delayed presentation of an acute complication is rarely observed.