Cecal perforation following cesarean section with generalized peritonitis
Presentation
Severe abdominal pain with fever and generalized abdominal tenderness 1 week following a cesarean section.
Patient Data
Large amount of air-fluid level in the peritoneal cavity (hydropneumoperitoneum) as well as free air-bubbles around the liver, spleen and in Douglas pouch. Extensive thickening and enhancement of the peritoneal reflections with mesenteric fat stranding.
Reactive thickening of the wall of the digestive structures including stomach, small and large bowels as well as the gallbladder wall.
A focal mural defect of the cecum measuring 23 mm in diameter indicating the site of perforation.
Annotated images: the green arrows indicate the site of cecal perforation.
Case Discussion
CT features of a cecal perforation following cesarean section with secondary generalized peritonitis.
There is a certain risk of paralytic distension of the bowel, especially of the coecum, during the initial post-operative days following cesarean section. As can be seen from the overview presented, the possible result is spontaneous perforation of the coecum, which frequently has lethal consequences
Bowel perforation is considered a rare complication following a cesarean section with an incidence around 0.08% 1. It may be iatrogenic or spontaneous in postoperative days due to a paralytic distension, especially of the cecum 2.
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