Vernix caseosa peritonitis

Abstract

Vernix caseosa peritonitis (VCP) is a rare and serious complication of caesarean section. It is thought to occur as a result of spillage of amniotic fluid and or meconium into the maternal peritoneal cavity at caesarean section. It manifests as an acute abdomen days to weeks after a seemingly uncomplicated caesarean section. Only 18 cases have been reported in the literature and all but one are from the USA. The pathophysiology is incompletely understood. In the past, the management of VCP included a laparotomy and removal of suspected abdominal organs which were invariably found to be normal on histopathological examination. However, the characteristic intraoperative finding was a cheesy white exudate that coats the visceral organs. The organs themselves were not inflamed. Histological examination of biopsy specimen of the cheesy exudates is the only way to make a diagnosis of VCP. This would reveal anucleate squamous cells along with lanugo hair and foreign body giant cell reaction. From recent case reports, peritoneal lavage appears to be the mainstay of treatment of VCP. Increased awareness of this condition is crucial so that it is considered in the differential diagnosis of post-caesarean acute abdomen thereby avoiding the unnecessary removal of healthy intra-abdominal organs. This review article summarises the current state of knowledge on VCP.

Vernix Caseosa Peritonitis after Vaginal Delivery

“…These squamous cells are described as being derived from fetal periderm. Numerous squamous cells are present in the amniotic fluid 4,5. The onset of peritonitis due to vernix caseosa occurring after uncomplicated cesarean sections has been attributed to incomplete peritoneal lavage of spilled amniotic fluid,7 although this spillage is usually insignificant and only rarely does it progress to peritonitis 13.…”

“…The nuclei are absent; however, nuclear ghosts are frequently present. Increased acid phosphatase enzyme activity is reported to be characteristic 4,5…”

“…Some authors have advocated postoperative antibiotic therapy 4–6,8,11,15. Adjuvant steroid therapy was used in two cases with resistant symptoms when infection has been excluded 8.…”

Vernix caseosa peritonitis: report of two cases

“…However, some cases of VCP develop in primiparous women suggesting that hypersensitivity reaction is less likely. The main symptoms of VCP are generalized severe abdominal pain, pyrexia, peritonism, and neutrophilic leukocytosis within 3 to 35 days following cesarean section (11,12). The imaging techniques show non-specific changes or are normal.…”

“…That treatment was a preference of the obstetrician. Some authors have advocated postoperative antibiotic therapy (5)(6)(7)(11)(12)(13), and even adjuvant steroid therapy in cases with resistant symptoms when infection has been excluded (6). However, these treatments remain empirical and controversial since none of them are really evidencebased (2).…”