Entrapment of viable trophoblastic tissue in a uterine hematoma after surgical evacuation. A case report.

Background: Postevacuation uterine perforation is a common event. Early diagnosis and management are important to minimize the associated morbidity and mortality.

Case: A woman presented with persistent vaginal bleeding for two weeks following surgical uterine evacuation for missed abortion at 7 weeks' gestation. She had a persistently elevated serum human chorionic gonadotropin level. Ultrasonography revealed a 3-cm, heterogeneous mass with high vascularity at the left anterior uterine fundal region; the endometrial echo was normal. Cornual pregnancy was suspected, and surgical resection was planned. Intraoperatively, a uterine hematoma with evidence of previous uterine perforation was diagnosed. Hysterotomy, removal of the hematoma and repair of the uterus were performed. Histologic examination revealed entrapment of trophoblastic tissue in the specimen. The patient had an uneventful recovery.

Conclusion: Entrapment of trophoblastic tissue in a uterine hematoma is a rare sequel of uterine perforation after evacuation and might be confused with cornual pregnancy.