背景技术子宫裂开,经常被误认为是子宫破裂的罕见事件,很少与剖宫产手术相关,并可能导致严重的并发症,尤其是产褥期败血症.在这份报告中,我们提供了一个案例,该案例举例说明了产褥期败血症的发作和下段剖宫产(LSCS)后子宫裂开引起的腹内脓肿的出现.病例报告我们的病人,一个28岁的女人第三次怀孕,一周前接受了LSCS。随后,她下腹痛回到医院,发烧,和恶臭的阴道分泌物.整个腹部的计算机断层扫描(CT)扫描证实了肝下区和右侧结肠旁沟的子宫裂开和脓液收集。转诊到专科医院后,实验室发现表明白细胞计数和碱性磷酸酶水平升高,和凝血异常。她做了剖腹探查术,揭示了子宫开裂,脓肿,和粘连,需要全腹部子宫切除术和腹部如厕。脓液培养分析确定了大肠杆菌的存在,对氨苄西林/舒巴坦敏感。手术后遇到并发症,包括伤口裂开和脓液再积聚.成功的管理包括真空敷料和经皮引流。最终,她的病情好转,出院了,没有额外的并发症。结论本报告强调了将剖宫产瘢痕裂开作为先前剖宫产妇女诊断的重要性,这些妇女在随后的妊娠期间出现腹痛或腹部败血症等症状。诊断工具,比如CT,发挥关键作用,当怀疑出现时,及时进行剖腹探查手术至关重要。
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.