Delayed Uterine Necrosis: Rare  Cause of Nonhealing Wound

Nigam, Aruna; Gupta, Neha; Elahi, Arifa Anwar; Jairajpuri, Zeeba S; Batra, Swaraj

doi:10.7860/jcdr/2016/20943.9058

Cited by 7 publications

(12 citation statements)

References 9 publications

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“…These procedures may be risk factors for infection as the tissue is devascularized. The only case similar to our case was described by Nigam et al, in which there was delayed myometrial necrosis after a primary cesarean delivery of a full term fetal demise with intra-amniotic infection [2]. Rivlin et al described uterine necrosis after cesarean delivery from group B beta-hemolytic Streptococcus [3].…”

Section: Discussionsupporting

confidence: 77%

“…The infection is typically polymicrobial involving a mixture of two to three anaerobes and aerobes form the lower genital tract. Early-onset infection and high fever are traditionally thought to be due to organisms such as group A or B beta-hemolytic Streptococcus [2]. Multidrug resistant organisms pose an increasing problem for patients resulting in septicemia and potential death.…”

Section: Introductionmentioning

confidence: 99%

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Multidrug-Resistant Escherichia coli Resulting in Postpartum Necrotizing Endomyometritis

Tymon‐Rosario

Chuang

2019

Case Reports in Obstetrics and Gynecology

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Background. Postpartum endometritis is a fairly common postoperative complication occurring in up to 11 percent of all cesarean deliveries. Multidrug-resistant pathogenic organism is increasingly a factor in postoperative source of infection. Postpartum endomyometritis from a multidrug-resistant Escherichia coli infection resulting in uterine is one such rare clinical circumstance where there is minimal information in the literature to guide its treatment and management. Case. A 29-year-old G1P0 who underwent a primary cesarean delivery for a failed induction of labor developed endomyometritis on post-op day one and was treated with multiple broad-spectrum antibiotic regimens. The source of infection was found to be multidrug-resistant Escherichia coli with uterine involvement and pelvic abscesses, requiring hysterectomy and drainage of pelvic abscesses. Severe uterine necrosis from this multidrug-resistant Escherichia coli infection was noted intraoperatively. After three weeks of antibiotic therapy, she had resolution of her infection. Conclusion. Multidrug-resistant Escherichia coli is a highly pathogenic organism that can cause endomyometritis, persistent bacteremia, and uterine necrosis, which necessitates definitive surgical management with hysterectomy to achieve resolution of the infection.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Multidrug-Resistant Escherichia coli Resulting in Postpartum Necrotizing Endomyometritis

Tymon‐Rosario

Chuang

2019

Case Reports in Obstetrics and Gynecology

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“…Uterine necrosis following caesarean section without any compression sutures or vessel ligation was also on record, and it was attributed to intrapartum sepsis. 12 The clinical presentation of uterine necrosis following compression sutures was fever, persistent pain abdomen, and evidence of sepsis. [8][9][10][11] The pre-operative diagnosis of uterine necrosis was difficult in this case as well as in other cases reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Conservative management of uterine necrosis following bilateral uterine vessels ligation and B-Lynch suture: Long term follow up

Dasari

2022

IJOGR

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A 29-year-old second gravida, previous abortion with twins, was induced at 32 weeks because of severe pre-eclampsia. Emergency caesarean section was needed for the second of twins, at which time she had an atonic postpartum haemorrhage. Bilateral uterine vessel ligation followed by B-Lynch suture was undertaken due to failure of medical measures. Post-operatively she had a stormy course with high spiking temperature and distension of abdomen and on imaging suspected foreign body in the uterus or uterine necrosis. At laparotomy, there was 6 liters of foul-smelling peritoneal fluid, and there was a deep groove on the uterus with impending perforation and partial necrosis of the uterus. After removing the suture, the perfusion slowly resumed, and hysterectomy was deferred. After five months, she expelled a necrotic tissue of the uterine cast. After six months, she resumed menstruation, and after three years, she had an intrauterine pregnancy, and presently, at five years, she has regular menstruation.

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“…As previously described, a pelvic abscess following cesarean delivery should be suspected in case of persistence of fever despite the use of intravenous antibiotics for more than 72 h [40,41]. The onset of symptoms ranged from 2 to 15 days after the cesarean delivery in 16 cases but it reached 6 -10 weeks in seven cases (Table 1) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Clinical Presentation and Timingmentioning

confidence: 99%

“…The lists of references of these articles were also reviewed. In total, we retrieved 17 articles reporting 23 cases similar to the present case [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] and one review article about the infected uterine incisional necrosis and dehiscence written by Rivlin et al in 2004 [20].…”

Section: Introductionmentioning

confidence: 99%

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

Badr¹,

Hassan²,

Ramadan³

2017

J Clin Gynecol Obstet

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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.

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Delayed Uterine Necrosis: Rare Cause of Nonhealing Wound

Cited by 7 publications

References 9 publications

Multidrug-Resistant Escherichia coli Resulting in Postpartum Necrotizing Endomyometritis

Multidrug-Resistant Escherichia coli Resulting in Postpartum Necrotizing Endomyometritis

Conservative management of uterine necrosis following bilateral uterine vessels ligation and B-Lynch suture: Long term follow up

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

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