Tubal ste r iliz ati on by minilaparotomy under local anesthesia is a safe, effective, low cost technique well sui ted for developing countries' . The death rate after tubal ligation is 2-10 perIOO,OOO ste riliz ati on s and is mainly due to general anesthesia or vascular injuries' .
Gut injury is a known complication of laparoscopic tubal steriliz ation", Even in minilap tubectomy, if there is a prev ious surgery or dense adhesions of the intestines with peritoneum, the surgeon can end up injuring the gut. It is unknown to have gut perforation in an uncomplicated case of minilap tubectomy. Here is a case of gut injury during minilap tubectomy that we came across for the first time in th e last 40 years.
A 24 ye ar old P2Ao was referred on iz" June, 2002 , in septic shock. Referral notes showed that sh e had minilap tubectomy performed at a community health center (CHC) on io" June, 2002 without any difficulty and was sent home after two hours in good health. It was not done in a camp . The next day she was readmitted to the CHC with th e complaint of pain in abdomen and vomiting and was admini stered broad spectrum injectable antibiotics. But her condition deteriorated very fast, so she was referred to us. On examination, her general condition was very poor, she was pale with cold extremities and had labored res piration. Her pulse rate was 140 min and systolic blood pressure 60 mmHg. The abdomen was distended, tense and tender with absent bowel sounds. The dressing was a dry covering, 2.5cm long, with apparently healthy stitch line in suprapubic region. There was no scar mark on the abdomen. Vaginal examination revealed tenderness and fullness in all the fornices due to which exact size of the uterus and adenexas could not be made out. Investigations showed Hb-8.5gm%, urine examination-normal, and serum electroly tes and coagulation profile within normal limits.
