Publication:

Pneumoperitoneum with peritonitis: an unseen, rare complication of postpartum caesarean uterine wound dehiscence

Pneumoperitoneum with peritonitis is very rare and life-threatening complication of post LSCS in postpartum period. Pneumoperitoneum is defined as presence of free air within the peritoneal cavity which can be associated with uterine scar dehiscence. We are presenting a case of pneumopyoperitoneum with uterine scar dehiscence on post operative day 6 of emergency LSCS which is successfully managed at our institution. A 22 years old female P1L1 with postoperative day 6 of emergency LSCS presented to labour room with chief complains of abdominal distension with pain abdomen since 1 day and on and off fever since 4 days with difficulty in breathing. On examination she was in septic shock. Her abdominal  X-ray showed air under diaphragm. The abdominal CT scan showed moderate to gross pneumoperitoneum extending into endometrial cavity through full thickness defect involving anterior myometrium in lower uterine segment suggestive of uterine rupture and also endometrial and intraperitoneal collections with multiple air foci . Emergency laparotomy was done and air escaped out with hissing sound. All the pus with blood was drained. Margins of uterine caesarean site were freshened and sutured. Gut was explored, no perforation was present. Postoperative period was uneventful. Pneumoperitoneum associated with peritonitis is a grave cause of maternal morbidity and mortality. Hence high index of suspicion with proper investigation and treatment can reduce morbidity associated with this condition, leading to  good future obstetric outcome of patient.