Case Report: Retroperitoneal Abscess After Uncomplicated Spontaneous Vaginal Delivery [19H

Abstract

INTRODUCTION: Retroperitoneal abscess following an uncomplicated vaginal delivery is uncommon and may be potentially life-threatening. We present a case of a multiparous 36 year old patient who developed a large retroperitoneal abscess following an uncomplicated vaginal delivery, requiring CT-guided fluid drainage and intravenous antibiotics. METHODS: Patient consent was obtained for this case report. Our patient is a 36 year old multiparous female who presented in spontaneous labor. She was febrile to 101.0 and started on empiric antibiotics. She underwent an uncomplicated spontaneous vaginal delivery with intact perineum without anesthesia. She remained afebrile and antibiotics were discontinued. Patient again developed fever to 102.5 prompting consult to infectious disease. Recommendation was made for broad spectrum antibiotics. She presented 3 weeks later with complaint of constipation, abdominal swelling, and pain. A palpable mass was noted, and patient was sent to the emergency department. CT scan showed heterogeneous fluid collection in the retroperitoneal left lower quadrant measuring 14.1 x 6.5 x 13.4 cm. Interventional radiology was consulted and she was taken for CT-guided drainage of fluid collection. Fluid culture resulted as Streptococcus pyogenes. IV antibiotics were adjusted based on culture and continued for 14 days. Follow up imaging demonstrated near-complete resolution of fluid collection. CONCLUSION: Diagnosis of a retroperitoneal abscess requires a high level of suspicion. In this case, we highlight the importance of postnatal follow-up and a low threshold for postpartum imaging. A multidisciplinary approach to treatment is important. Initiation of broad-spectrum antibiotics and drainage of the abscess should be arranged if diagnosis is made.