Sonographic identification of an unusual complication of midtrimester pregnancy termination: unrecognized intra-abdominal extrusion of fetal parts.

A 25-year-old woman (G3P2) underwent an uneventful elective pregnancy termination of a 16week gestation by dilatation and evacuation (D&E) under general anesthesia. Two days later she was admitted with left lower quadrant pain, fever, and a hematocrit of 29.1. A curette was passed to 13 cm, eliciting back pain but yielding no tissue. Laparoscoy revealed considerable intra-abdominal blood, and immediate laparotomy confirmed a 10-cm posterior uterine tear. Following uterine repair, the remainder of the pelvis and accessible abdominal contents were thoroughly inspected and considered normal. Despite antibiotic coverage, a postoperative fever persisted on postoperative day 6, and the left lower quadrant pain was increasing. Pelvic examination was unrevealing and pelvic sonography was requested. While no pelvic abnormal-