Uterine Perforation and Bowel Injury During D&C: Risks, Symptoms, and Prevention

Dilation and curettage (D&C) carries rare but serious complications.

Incidence

• Uterine perforation: 0.1–0.5%
• Bowel injury: <0.1%

Risk Factors

• Excessive force / inexperienced operator
• Uterine anomalies (septate, bicornuate)
• Prior uterine surgery (C‑section, myomectomy) → scarring
• Pregnancy (softer uterus)
• Postmenopausal atrophy

Symptoms

• Perforation: Severe abdominal pain, vaginal bleeding, fever, nausea, shoulder tip pain (diaphragmatic irritation).
• Bowel injury: Abdominal pain, distension, nausea/vomiting, diarrhea, rectal bleeding, fever.

Management

• Diagnostic laparoscopy if suspected.
• Perforation: Often observe with antibiotics; large defects may need laparoscopic repair.
• Bowel injury: Requires surgical repair (resection/anastomosis), antibiotics, possible colostomy.

Prevention

• Ultrasound guidance for difficult anatomy.
• Blunt curettes, careful depth assessment.
• Pre‑op counseling for high‑risk patients.