Spontaneous delayed uterine perforation in a primigravida post-caesarian section an unheard entity

To report a case of spontaneous delayed uterine perforation post-cesarean section in a primigravida. A 26 year woman came with the complaints of abdominal pain since two days. Detailed history revealed that she was a primigravida who had undergone an elective cesarean section six weeks back. Ultrasonography of the whole abdomen was performed followed by MDCT of abdomen and pelvis on a 128 multi slice scanner for imaging evaluation of the patient. Ultrasonography revealed moderate amount of free fluid in the lower abdomen. Further a contrast enhanced Multi-detector computed tomography scan revealed loculated collections in the pelvis and a rent along the right postero-lateral wall of the uterus which also showed endometrial collection with within. Surgical exploration confirmed the uterine perforation and pelvic collections. Surgical repair of the uterine rent and peritoneal lavage were carried out. A spontaneous uterine perforation in a primigravida after weeks of uneventful post-cesarean recovery period is not documented in current English literature, hence we are lead to share our imaging findings to create medical awareness of such an entity.