Hegar uterine dilator as an unusual cause of small bowel obstruction: a case report
© Okorie; licensee BioMed Central Ltd. 2010
Received: 19 September 2009
Accepted: 6 July 2010
Published: 6 July 2010
The unusual event of surgical instrument retention in the abdominal cavity usually occurs after laparotomy.
A 45-year-old African woman from Cameroon with no previous abdominal surgery presented with a three-day history of colicky abdominal pain. Abdominal X-ray showed an opaque, linear object in the lower abdomen. Exploratory laparotomy revealed a Hegar uterine dilator that was lost during a dilatation and curettage performed seven years prior to the present admission.
The trans-uterine route should be included as a rare and unusual source of surgical instruments retained in the abdomen.
Surgical instruments retained intra-abdominally usually occur after abdominal surgery and are straightforward to diagnose in conjunction with a history of previous laparotomy. Establishing the diagnosis pre-operatively of an abdominally retained surgical instrument in the absence of previous abdominal surgery will certainly be more challenging. Documenting and reporting all cases of retained surgical instruments not originating from previous abdominal exploration will help build a database and will educate physicians on how to avoid this dangerous medical error. From a literature search (Pubmed and Medline with no limitations until 2009) using search terms: abortion, Hegar uterine dilator, retained intra-abdominal surgical instruments, and bowel obstruction, no similar case reports were found. Hence, this case report documents the only known loss of a Hegar uterine dilator into the abdominal cavity during an abortion.
Surgical instruments left in the abdominal cavity are an uncommon but dangerous surgical error  usually occurring during abdominal surgery. The presence of foreign bodies in the abdominal cavity can lead to the formation of adhesions , which are the most common cause of small bowel obstruction [3, 4]. This case is unique in that the source of the intra-abdominal foreign body could not be determined or even imagined until surgery, and likewise our patient could not have related an abortion performed seven years prior to her present problem.
This case certainly calls for inclusion and early consideration of a trans-uterine source in the differential diagnosis of intra-abdominal foreign bodies including surgical instruments. As natural orifice trans-lumenal endoscopic surgery (NOTES) gains momentum, such cases may become more frequent.
The trans-uterine route should be included as a rare and unusual source of surgical instruments retained in the abdomen. This case can assist in the future development of a classification system for various routes of abdominally retained surgical instruments, as this case demonstrates a source other than previous laparotomy.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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