Complete uterine rupture in the second trimester of pregnancy and covered by greater omentum to stop bleeding：a case report

Abstract Background: Uterine rupture usually occurs during delivery, acompany with abnormal fetal heart rate, acute blood loss and hemorrhagic shock. But in our case, the rupture happened on the 20th weeks, the location of uterine rupture was not at common surgical incision, and because of the rupture was covered by the greater omentum, the patient didn’t have severe tearing pain, hypovolemic shock, significant decrease in hemoglobin, vaginal bleeding, and normal fetal heart rate. It was a situation that was easy to miss diagnosis and cause serious maternal complications. Case presentation: A 24-year-old G2C1 pregnant woman was admitted to our hospital due to "20 + 5 weeks of menopause, epigastric and right lower abdominal pain with nausea and vomiting for 6 days". The patient underwent laparoscopic exploration, and During the laparoscopic exploration: the appendix, intestine, spleen, ovary and other abdominal organs were normal, we only found the fundus of the uterus was adherent to the greater omentum, and the remaining uterus was smooth. Only by decisively separating the greater omentum from the position of close adhesion with the uterus can the rupture be seen. After separating, the amniotic sac ruptured naturally, a male stillborn fetus was delivered through the rupture and we suture the rupture. Conclusions: For the first and second trimester of pregnancy, abdominal pain is the only major clinical symptom of uterine rupture, and the pain is non-specific, starting a few hours to a few days before the diagnosis. Uterine rupture usually happens after uterine surgery, placental implantation, improper use of uterine contraction drugs, and obstetric surgical procedures. These suggest that uterine rupture should be considered in the diagnosis of all pregnant women with acute abdomen pain. The greater omentum as a source of resident inflammatory cells and stem cells that can be used to participate in the local control of infection, wound healing, and tissue regeneration. If patients’ symptom is untypical, we should take attention to the greater omentum’s influences.