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07 April 2024 : Case report  Thailand

[In Press] Severe Complications of Uterine Dehiscence Post-Lower Segment Cesarean Section: A Case Report Emphasizing the Importance of Timely Diagnosis and Intervention

Unusual clinical course, Challenging differential diagnosis, Management of emergency care, Patient complains / malpractice, Educational Purpose (only if useful for a systematic review or synthesis)

Saifon Chawanpaiboon ORCID logo1ABCDEFG, Nalat Sompagdee1BE, Sriwipa Kaewsrinual1BE, Kanitta Srikrisanapol1BE, Anupop Jitmuang2B, Piyawat Matrakool3B, Jirawadee Yodying4B, Taksaporn Sakrattana-anant1B, Piyawadee Wangmanao1B, Pornphet Songsirithat1B, Runchida Saengsiriwudh1B, Kongkaew Ngowsirigool1B, Jirapon Jesrichai2B, Techin Wasinsangworn3B

DOI: 10.12659/AJCR.943027

Am J Case Rep In Press; DOI: 10.12659/AJCR.943027  

Available online: 2024-04-07, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Uterine dehiscence, an infrequent event often mistaken for uterine rupture, is rarely linked to post-cesarean section procedures and can result in severe complications, notably puerperal sepsis. In this report, we present a case that exemplifies the onset of puerperal sepsis and the emergence of intra-abdominal abscesses attributed to uterine dehiscence following a lower segment cesarean section (LSCS).
CASE REPORT
Our patient, a 28-year-old woman in her third pregnancy, underwent LSCS 1 week earlier. Subsequently, she returned to the hospital with lower abdominal pains, fever, and malodorous vaginal discharge. Computed tomography (CT) scan of whole abdomen verified uterine dehiscence and pus collection at the subhepatic region and right paracolic gutter. After referral to a specialized hospital, laboratory findings indicated an elevated white blood cell count and alkaline phosphatase levels, and coagulation abnormalities. She underwent an exploratory laparotomy, which unveiled uterine dehiscence, abscesses, and adhesions, necessitating a total abdominal hysterectomy and abdominal toileting. Pus culture analysis identified the presence of E. coli, which was susceptible to ampicillin/sulbactam. Complications were encountered after surgery, including wound dehiscence and pus re-accumulation. Successful management involved vacuum dressings and percutaneous drainage. Eventually, her condition improved and she was discharged, without additional complications.
CONCLUSIONS
This report underscores the importance of considering cesarean scar dehiscence as a diagnosis in women with previous cesarean deliveries who present during subsequent pregnancies with symptoms such as abdominal pain or abdominal sepsis. Diagnostic tools, such as CT, play pivotal roles, and the timely performance of an exploratory laparotomy is paramount when suspicion arises.

Keywords: Abscess; Cesarean Section; Diagnosis; Puerperal Infection; Surgical Wound Dehiscence

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Severe Complications of Uterine Dehiscence Post-Lower Segment Cesarean Section: A Case Report Emphasizing t...

Am J Case Rep In Press; DOI: 10.12659/AJCR.943027  

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923