Uterine Dehiscence: A Rare Cause of Postpartum Puerperal Sepsis.

Manjunath Haridas,Amey Joshi,Venkata Jaya Divya Tenneti

doi:10.7759/cureus.18264

Abstract

Uterine dehiscence (partial or complete) is a rare complication of lower segment cesarean section (LSCS). Puerperal sepsis with intra-abdominal abscess following this event has been rarely reported. The delay in diagnosis and management of the condition can result in significant morbidity and mortality. We herein report three cases of puerperal sepsis along with intra-abdominal abscess associated with uterine dehiscence following LSCS. These patients in the current case series presented with complaints of fever and abdominal pain. Early recognition and prompt treatment with diagnostic laparoscopy and or laparotomy with drainage were effective in the management of these patients.

Highlights

Uterine dehiscence (UD) due to endomyometritis in the postpartum period, following lower segment cesarean section (LSCS) delivery, is an infrequent occurrence with limited literature [1]
Similar outcomes have been observed in cases of faulty approximation of the myometrium during LSCS, which allowed the gradual spread of intra-uterine pathological organisms into the peritoneal cavity [2,4]
We report the presentation and successful management of three cases of puerperal sepsis following uterine dehiscence, which were complicated with the formation of intra-abdominal abscesses

Summary

Introduction

Uterine dehiscence (UD) due to endomyometritis (puerperal sepsis) in the postpartum period, following lower segment cesarean section (LSCS) delivery, is an infrequent occurrence with limited literature [1]. Postoperative day four was significant for fever spikes with increased white blood cell count (24,000/cumm) requiring antibiotics as per pus culture sensitivity reports. A 31-year-old primigravida with an unremarkable antenatal history had delivered a full-term baby by an uncomplicated elective LSCS at an outside facility She initially complained of lower abdominal pain which was managed conservatively. A dense loculated purulent fluid was adherent to the anterior abdominal wall and the anterior aspect of the uterus and bowel loops This was excised and sent for culture and sensitivity. Four days following LSCS, the patient developed abdominal distension, shortness of breath which was managed on an outpatient basis by her obstetrician and cardiologist She later presented with intermittent fever which gradually worsened and brought her to our emergency room on day 10 of puerperium.

Discussion

Conclusions

Disclosures

Sholapurkar SL