Patterns of bowel injuries and its management outcomes in unsafe abortion

Aim: to study the pattern of bowel injuries after induced abortion and morbidity and mortality associated with it. design: retrospective study. method: the study was conducted in west surgical unit of mayo hospital,lahore over a period of two years from 1st jan 2009 to 31st dec 2010,comprising 32 patients. results: study includes 32 patients. mostly young female with age ranging from 19-43 (mean 27.46) years. 29(90.6%) patients were married and 3(9.3%) were unmarried. all patients underwent exploratory laparotomy and it was found that 18(56.2%) patients were having small bowel injury out of which 15(46.8%) patients were having ileal injury,2(6.2%) jejunal perforation and 1(3.1%) were having both jejunal and ileal perforation. large bowel was injured alone in 12(37.5%) out of which transverse colon injury seen in 1(3.1%) and sigmoid colon in 11(34.3). in 2(6.2%) both small and large intestine were injured. in 3 (9.3%) small intestine was seen coming through vagina. severe hemorrhage occurred in 7(21.8%),primary repair was done in 2(6.2%) with jejunal injury and 2(6.2%) with ileal perforation with minimal contamination due to early presentation. ileostomy was done in 13(40.6%). for large bowel injury loop colostomy in 7(21.8%),hartmann's procedure in 2(6.2%) and colostomy with mucous fistula performed in 3(9.3%) patients. wound infection seen in 9(28.1%),wound dehiscence in 4(12.5%),pelvic abscess in 3(9.3%),one patient abdomen was not possible to close primarily due to late presentation leading to gut edema so boghota bag was applied. mortality seen in 5(15.6%) patients. conclusion: injuries to intestine is most common during abortion whether legal or illegal,when performed by unqualified personnel i.e. dais,nurses and quacks. morbidity and mortality increases with late presentation to the hospital due lack of assessment of complications by them. such complications can be over come if performed by qualified medical personnel with all the heath care facilities and proper legislation.