English

Abstract

Generalized peritonitis following lower segment caesarean section with uterine incision necrosis and dehiscence presenting as genitourinary fistula is very unusual. Herein we report a case of 28 years old woman who was received in emergency hours as a referred case from a private nursing home with history of caesarean section done 11 days back for premature rupture of membranes and pregnancy induced hypertension. She came with complaints of continuous watery discharge per vaginum, high grade fever with chills and rigor, nausea, vomiting, breathlessness, severe diffuse abdominal pain and distension of abdomen since last 4-5 days. Here acute abdomen series was done. The urologist ruled out genitourinary fistula. CECT of abdomen was done. She was diagnosed to be a case of generalized peritonitis following caesarean section with necrosis and dehiscence of suture line of uterus through which ascitic fluid was being drained into vagina. Consequently, patient underwent laparotomy. Gentle adhesiolysis with supra cervical hysterectomy was done. Thorough drainage and irrigation of pelvi-abdominal cavity was done. Post-operative period was uneventful. INTRODUCTION: It is unusual for peritonitis to develop following caesarean delivery. It is almost invariably preceded by metritis and uterine incisional necrosis and dehiscence. Other cases may be due to inadvertent bowel injury at caesarean delivery. Yet another cause is peritonitis following rupture of a parametrial or adnexal abscess.1 Herein we report a case of 28 years old woman who was received in emergency hours as a case of post-operative caesarean section which was done in a private nursing home 11 days back. She presented with complaints of continuous watery discharge per vaginum, high grade fever with chills and rigor, nausea, vomiting, breathlessness, severe diffuse abdominal pain and distension of abdomen since last 6-7 days. The first clinical impression that she gave was that of a genitourinary fistula following caesarean section. After complete work up, her provisional diagnosis was to be a case of generalized peritonitis following post caesarean uterine wound necrosis with dehiscence and the ascitic fluid was being drained through this uterine rent. Emergency laparotomy was done. Gentle adhesiolysis with supracervical hysterectomy was done. Post-operative period was uneventful.