A 24-year-old woman undergoes first-trimester surgical abortion by suction evacuation. Post-procedure, she develops acute abdominal pain with a rigid abdomen and free air on X-ray. The MOST likely complication is:
- A Uterine perforation with bowel injury ✓
- B Vasovagal reaction
- C Cervical shock
- D Incomplete abortion with haematometra
Correct answer: A. Uterine perforation with bowel injury
Explanation
Free air under the diaphragm on erect X-ray after uterine instrumentation indicates bowel perforation secondary to uterine perforation — the cannula or curette perforated the uterine fundus and entered the bowel. This requires urgent laparotomy for bowel repair and uterine closure. Vasovagal reaction causes bradycardia and hypotension without peritonitis; cervical shock is due to cervical manipulation; haematometra would show an enlarged uterus without free air.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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