Presentation
5 days post emergency LUSCS with worsening pain and distension.
Patient Data
There is fluid and gas extending from the lower uterine segment anteriorly and to the left in keeping with dehiscence of the lower segment cesarean section incision. There is some pelvic free fluid, fat stranding and fluid within the peritoneal cavity between the uterus and the rectus sheath. No dehiscence of the rectus sheath incision.
Large and small bowel are dilated with no transition point identified. Features are in keeping with post-operative ileus.
Minor intra and extra-hepatic bile duct dilatation is noted. The remaining solid organs are normal.
Bilateral pleural effusions are slightly larger on the right side. Adjacent atelectasis in the lower lobes posteriorly. No bony abnormality.
Conclusion
evidence of dehiscence of the lower segment cesarean section incision.
post-operative ileus.
post-operative pleural effusions and basal atelectasis.
Case Discussion
The patient underwent emergency surgery to repair the dehiscent uterus but it could not be repaired and a hysterectomy was required. The patient then had an uncomplicated post-operative course.
Interestingly classical transverse C/S scars are more likely to rupture before labor, whereas lower uterine segment C/S scars (LSCS) tend to rupture after labor.
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