Spontaneous uterine rupture masquerading as intestinal perforation in a primigravida with polyhydramnios

Shruti Raut, Vandana Rajesh Saravade
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2025 · vol. 14(9) , pp. 3146–3148 · doi:10.18203/2320-1770.ijrcog20252757 · W4413800633
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This case report describes a rare spontaneous uterine rupture in a primigravida presenting with symptoms mimicking intestinal perforation, requiring surgical intervention and emphasizing diagnostic considerations.

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This paper reports a rare case of spontaneous rupture of an unscarred uterus in a 26-year-old primigravida at 36 weeks who was referred with suspected intestinal perforation. Cross-sectional imaging showed a uterine fundal rent with hemoperitoneum, and surgery found dense pelvic adhesions, fat stranding, and a ruptured dilated vessel over the uterine rent, interpreted as possible chronic pelvic inflammation possibly related to endometriosis or prior subclinical pelvic inflammatory disease. The authors emphasize that uterine rupture should be considered in unscarred uteri when presentations are atypical, but this is limited by being a single case report without confirmatory evidence of the underlying cause. This paper is centrally about endometriosis — it discusses chronic pelvic inflammation possibly due to endometriosis and cites endometriosis-related uterine rupture in pregnancy in its clinical context.

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Abstract

Spontaneous rupture of an unscarred uterus in a primigravida is an exceptionally rare and life-threatening event. We report the case of a 26-year-old primigravida at 36 weeks who was referred as a suspected case of intestinal perforation. Cross-sectional imaging revealed a uterine fundal rent with hemoperitoneum. Intraoperative findings included dense pelvic adhesions, fat stranding, and a ruptured dilated vessel over the uterine rent, suggestive of chronic pelvic inflammation possibly due to endometriosis or prior subclinical pelvic inflammatory disease. This case highlights the importance of considering uterine rupture in unscarred uteri, particularly when atypical presentations occur.
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Spontaneous uterine rupture masquerading as intestinal perforation in a primigravida with polyhydramnios DOI: https://doi.org/10.18203/2320-1770.ijrcog20252757Keywords: Hemoperitoneum, Uterine rupture, Chronic pelvic inflammationAbstract Spontaneous rupture of an unscarred uterus in a primigravida is an exceptionally rare and life-threatening event. We report the case of a 26-year-old primigravida at 36 weeks who was referred as a suspected case of intestinal perforation. Cross-sectional imaging revealed a uterine fundal rent with hemoperitoneum. Intraoperative findings included dense pelvic adhesions, fat stranding, and a ruptured dilated vessel over the uterine rent, suggestive of chronic pelvic inflammation possibly due to endometriosis or prior subclinical pelvic inflammatory disease. This case highlights the importance of considering uterine rupture in unscarred uteri, particularly when atypical presentations occur. Metrics References Sun HD, Su WH, Chang WH, Wen L, Chen M. Spontaneous uterine rupture in an unscarred uterus: a rare but life-threatening event. Am J Emerg Med. 2012;30(9):5-7. Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine rupture: risk factors and pregnancy outcome. Am J Obstet Gynecol. 2003;189(4):1042-6. DOI: https://doi.org/10.1067/S0002-9378(03)01052-4 Yasmin F, Mubeen N, Goraya S. Spontaneous rupture of unscarred uterus in a primigravida at 32 weeks: a rare case report. J Pak Med Assoc. 2020;70(11):2083-5. Breen JL, Neubecker R, Gregori CA, Franklin JE. Spontaneous rupture of the uterus. Obstet Gynecol. 1977;50(5):541-6. Benagiano G, Brosens I, Habiba M. Structural and molecular aspects of uterine rupture in pregnancy. J Matern Fetal Neonatal Med. 2012;25(1):17-20. Kamara M, Penava D, Jaeger M, Mehta S. Spontaneous rupture of the uterus in the third trimester after an uneventful vaginal birth. J Obstet Gynaecol Can. 2013;35(10):928-32. Brosens I, Brosens JJ, Fusi L, Al-Sabbagh M, Kuroda K, Benagiano G. Risks of adverse pregnancy outcomes in endometriosis. Fertil Steril. 2012;98(1):30-5. DOI: https://doi.org/10.1016/j.fertnstert.2012.02.024 Leone Roberti Maggiore U, Ferrero S, Mangili G, Bergamini A, Inversetti A, et al. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update. 2016;22(1):70-103. DOI: https://doi.org/10.1093/humupd/dmv045 Varras M, Akrivis C, Kalles V, Plis C. Endometriosis causing uterine rupture during pregnancy: a case report. Cases J. 2009;2:9327. DOI: https://doi.org/10.1155/2009/180643

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