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Case Report
A rare complication of dilation and evacuation: Unrecognized extrauterine retained products of conception
1 DO, PGY-2, Obstetrics and Gynecology, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA, United States
2 MD, PGY-6, Division of Minimally Invasive Gynecologic Surgery, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA, United States
3 MD, Division of Minimally Invasive Gynecologic Surgery, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA, United States
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Aviana Terschueren
VHS Eastern Virginia Medical School at Old Dominion University, 825 Fairfax Avenue #544, Norfolk, VA 23507,
United States
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Article ID: 100219Z08AT2025
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Terschueren A, Siewertsz van Reesema L, Hudgens J. A rare complication of dilation and evacuation: Unrecognized extrauterine retained products of conception. J Case Rep Images Obstet Gynecol 2025;11(2):50–54.ABSTRACT
Introduction: Surgical abortions, including dilation and evacuation, are among the safest gynecological procedures, with complication rates ranging from 0.5–4.0%. Uterine perforation, though rare (0.2–0.8%), can result in serious sequela, including translocation of retained products of conception into the abdominal cavity. We present a rare case of abdominal retained products of conception following a second-trimester dilation and evacuation.
Case Report: A 29-year-old G3P1112 underwent an elective surgical abortion at 17 weeks’ gestation, complicated by hemorrhage necessitating transfer to an outside hospital. She was treated with uterotonics and a blood transfusion and was discharged after a 6-day hospitalization. Initial transvaginal ultrasound showed no intrauterine retained products of conception, though a right adnexal cyst was noted. Eight days later, she re-presented with similar symptoms. Abdominal imaging was suggestive of an intra-abdominal fetal skull. She was transferred to our facility for surgical evaluation. Exploratory laparoscopy identified a 4×4 cm inflammatory mass adherent to the uterine fundus and abdominal wall, containing purulent fluid and fetal calvarium. A mesenteric defect in the sigmoid colon suggested prior instrumentation injury, though the bowel lumen remained intact. The mass was excised, and pathology confirmed degenerative fetal tissue. The patient recovered well post-operatively.
Conclusion: This case highlights the importance of confirming complete evacuation following a second-trimester surgical abortion and maintaining high clinical suspicion for extrauterine retained products of conception in patients with persistent symptoms, even in the absence of obvious intrauterine findings. Magnetic resonance imaging may be helpful in equivocal cases, and diagnostic laparoscopy should be considered when imaging and clinical presentation are inconclusive.
Keywords: Dilation and evacuation, Retained products of conception, Surgical complication, Uterine perforation
SUPPORTING INFORMATION
Acknowledgments
An AI technology, CHATGPT (GPT-5 model), was utilized for editing of this case report. Specifically, it was used to help edit and organize the writing in the abstract section labeled “Case Report” and “Conclusion.” It was also utilized to help edit the writing in some of the introduction section. This technology was not used to gather information and was only used for editing purposes.
Author ContributionsAviana Terschueren - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Lauren Siewertsz van Reesema - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Joseph Hudgens - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Aviana Terschueren et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
