Uterine dehiscence post Caesarean section

Case contributed by Dr Craig Hacking

Presentation

5 days post emergency LUSCS with worsening pain and distension.

Patient Data

Age: 35 years
Gender: Female

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 labour, whereas lower uterine segment C/S scars (LSCS) tend to rupture after labour.

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Case information

rID: 34690
Case created: 5th Mar 2015
Last edited: 27th Sep 2017
System: Obstetrics
Inclusion in quiz mode: Included

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