Uterine suture dehiscence and tubo-ovarian abscess

Case contributed by Bahman Rasuli
Diagnosis almost certain


Two weeks history of right lower abdominal pain with tenderness, fever, and elevated inflammatory markers in a patient with a history of cesarian section three weeks prior.

Patient Data

Age: 30 years
Gender: Female

There is a 70 x 95 x 110 mm large multiloculated thick-walled collection in the right iliac fossa with wall and septa enhancements.

Surrounding inflammatory changes of the mesenteric fat with thickening and enhancement of the peritoneal reflections.

The right ovary and fallopian tube cannot be separately distinguished within the inflammatory mass.

Enlarged uterus with mixed air and fluid-filled collection within the uterine cavity in continuity with the pre-uterine collection and right sided tubo ovarian abcess through a defect of the anterior lower uterine wall at the incision site.

Normal appearance of the left ovary.

Case Discussion

The clinical presentation and CT features are in keeping with a large tubo-ovarian abscess on the right side and pre-uterine intraperitoneal air-fluid collection complicating dehiscence of the lower segment cesarean section incision.

Risk factors for tubo-ovarian abscesses include:

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