Conservative Surgical Management of Uterine Incisional Necrosis and Dehiscence After Primary Cesarean Delivery Due to Proteus mirabilis Infection: A Case Report and a Review of Literature

Abstract

We hereby describe the conservative surgical management of a case of infected uterine incisional necrosis and dehiscence after primary cesarean delivery, and report our brief review on risk factors, physiopathology and the management of this postpartum complication. We encountered a 25-year-old woman presenting to our emergency department (ED) with severe suprapubic pain and high grade fever. She had an urgent cesarean delivery performed 10 days prior to presentation due to fetal distress. At the ED, CT scan of pelvis was ordered and showed an intraperitoneal collection anterior to the uterus at the level of the uterine cesarean scar. Exploratory laparotomy showed a uterine rupture at the previous incision site. We performed resection of necrotic edges, peritoneal lavage, approximation of uterine edges with separate interrupted sutures, placement of a suction drain in the cul-de-sac and a passive drain inside the uterine cavity through the cervix and vagina. Postpartum uterine scar rupture secondary to infection and necrosis is a rare but serious complication of cesarean delivery. Conservative management by drainage and resection of necrotic edges in addition to intravenous antibiotics may be considered as an option before resorting to hysterectomy in selected young patients. A low threshold to diagnose this complication is warranted.




J Clin Gynecol Obstet. 2017;6(3-4):65-70
doi: https://doi.org/10.14740/jcgo451w