September 27th, 2020

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Uterine Scar Rupture in the Setting of Hematometra with Cervical Stenosis: A Case Report
Authors:  Martha Claire Thomas, M.D., Elizabeth A. Lutz, M.D., M.S., and James M. Shwayder, M.D., J.D.
BACKGROUND: Hematometra with uterine rupture should be considered in a patient with a prior cesarean delivery and loop electrical excision procedure (LEEP) who presents with acute abdominal pain.

CASE: A 28-year-old woman was transferred from an outside hospital with acute abdominal pain and a possible intraabdominal abscess. Her history revealed an emergent classical cesarean section and LEEP for cervical intraepithelial neoplasia. Examination revealed a stenotic cervix and a minimally enlarged, tender uterus. Imaging revealed hematometra, with fluid tracking through the old cesarean incision into the anterior lower abdomen. Surgical exploration confirmed uterine rupture. She underwent extensive enterolysis and total abdominal hysterectomy.

CONCLUSION: In a patient with acute abdominal pain with a prior cesarean delivery and LEEP procedure, it is important to consider cervical stenosis, hematometra, and uterine rupture.
Keywords:  acute abdominal pain, adhesiolysis, bilateral salpingectomy, cervical intraepithelial neoplasia, cervical stenosis, cesarean section, cystoscopy, enterolysis, hematometra, intraabdominal abscess, LEEP, loop electrical excision procedure, total abdominal hysterectomy, uterine rupture, uterine scar dehiscence
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