Title : Successful cesarean section for a ruptured uterus with severe intra-abdominal pus collection: A case report
Abstract:
A 32-year-old gravida 2 para 1 unbooked pregnant patient presented to the emergency department with severe abdominal pain and fresh moderate vaginal bleeding that started a couple of hours prior. Her gestational age (GA) at the time of presentation was 27 weeks and 2 days by her last menstrual period (LMP). On per abdominal examination, her abdomen was found to be soft, while per vaginal examination revealed a posterior cervix with the os closed and a fetal body part was felt at the right adnexa. A bedside abdominal ultrasound scan was performed, and a single live fetus was found with fluid collection around the fetal head. Hence, a diagnosis of uterine rupture was made, and the patient was shifted to the operation room for an emergency lower segment cesarean section (LSCS) under general anesthesia. The patient delivered an 800- gram live baby. Intraoperatively, it was found that there was a chronic, complete rupture of the uterus at the previous scar with large amounts of intraabdominal and uterine pyogenic collections. Postoperatively, the patient was then shifted to the intensive care unit (ICU), where she was given intravenous antibiotics, which improved her clinical condition. During the remainder of her stay, she made an uneventful recovery and was discharged.
Audience Take Away:
- Importance of early pregnancy assessment especially in women with previous cesarean section even if only one previous cesarean.
- Unusual presentation of uterine rupture and to be keep in mind the diagnosis of uterine rupture even if the patient has no clear signs and symptoms.
- What makes us to publish the case, is the amount of pus was intraopertively although the patient’s symptoms was not up to that severity.
- The culture result which was positive to Citrobacter Freundii bacteria, rarely to be found abdominal, as it is zoonotic infection one of our conclusions after research is that the patient had a pet at home which might be the cause.
- The successful cesarean section with following up the patient post operatively as she had in eventful post parting course.
- Encourage the multidisciplinary teams approach to patients, starting from family physicians, early assessment of the pregnancy and obstetricians.
