The patient was a 15-year-old girl employed in a local bar. She was admitted to hospital after a knife fight involving her, a former lover and a new boyfriend. Who stabbed whom was not quite clear but all three participants in the small war were admitted with knife injuries.
The girl had some minor lacerations of the left hand and a single stab-wound in the upper abdomen. Under general anaesthesia, laparotomy was performed through an upper midline abdominal incision to reveal two holes in the stomach. These two wounds had resulted from the single stab-wound through the abdominal wall. The two defects were repaired in two layers. The stomach was noted empty at the time of surgery and no gastric contents were seen in the abdomen. Nevertheless, the abdominal cavity was lavaged with normal saline before closure. The condition of the patient improved rapidly following routine postoperative care and she was discharged home after 10 days.
Precisely 278 days later the patient was admitted again to hospital with acute, intermittent abdominal pain. Abdominal examination revealed a term pregnancy with a cephalic fetal presentation. The uterus was contracting regularly and the fetal heart was heard. Inspection of the vulva showed no vagina, only a shallow skin dimple was present below the external urethral meatus and between the labia minora. An emergency lower segment caesarean section was performed under spinal anaesthesia and a live male infant weighing 2800g was born. [...]
The patient was well aware of the fact that she had no vagina and she had started oral experiments after disappointing attempts at conventional intercourse. Just before she was stabbed in the abdomen she had practised fellatio with her new boyfriend and was caught in the act by her former lover. The fight with knives ensued. She had never had a period and there was no trace of lochia after the caesarean section. [...]
A plausible explanation for this pregnancy is that spermatozoa gained access to the reproductive organs via the injured gastrointestinal tract.