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Case Reports in Obstetrics and Gynecology
Volume 2014, Article ID 720181, 3 pages
http://dx.doi.org/10.1155/2014/720181
Case Report

Perforation of the Pregnant Uterus during Laparoscopy for Suspected Internal Herniation after Gastric Bypass

1Department of Gastroenterologic Surgery, Oslo University Hospital, Pb 4950 Nydalen, 0424 Oslo, Norway
2Department of Gynecology and Obstetrics, Oslo University Hospital, 4950 Oslo, Norway
3Department of Anaesthesiology, Oslo University Hospital, 4950 Oslo, Norway

Received 12 August 2014; Accepted 1 November 2014; Published 18 November 2014

Academic Editor: Eliezer Shalev

Copyright © 2014 T. Mala et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report perforations of a pregnant uterus during laparoscopy for suspected internal herniation after gastric bypass at 24 weeks of gestation. Abdominal access and gas insufflation were achieved by the use of a 12 mm optic trocar. An additional 5 mm trocar was positioned. The perforations were handled by suturing following laparotomy and mobilisation of the high located uterus. The uterine fundus was located in the subcostal area. Internal herniation was not verified. A cesarean section was made 6 weeks later due to acute low abdominal pain. During delivery the uterus was found normal. At 5 months of age the child has developed normal and seems healthy. Optical trocars should be used with caution for abdominal access during laparoscopy in pregnancy. Open access should probably be preferred in most cases. Accidental perforations of the uterine cavity may be handled in selected cases with simple closure even following the use of large trocars under close postoperative surveillance throughout the pregnancy.