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. 2016 Nov;10(11):QJ01-QJ02.
doi: 10.7860/JCDR/2016/20920.8833. Epub 2016 Nov 1.

Post-caesarean Haematomas, Septic Collections and Wound Disruptions- Re-Laparotomy Based on Abdominal Imaging

Akhila Vasudeva  1 , Sapna Vinit Amin  1 , Koteshwara Prakashini  2 , Sunanda Bharatnur  1 , Anjali Mundkur  1
Affiliations

Post-caesarean Haematomas, Septic Collections and Wound Disruptions- Re-Laparotomy Based on Abdominal Imaging

Akhila Vasudeva et al. J Clin Diagn Res. 2016 Nov.
No abstract available

Keywords: Post-caesarean sepsis; Ultrasound; Uterine wound dehiscence; Vesical flap haematoma.

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Figures

[Table/Fig-2]:
[Table/Fig-2]:
(a) Haematoma seen bulging the UV fold of peritoneum, containing mixed echogenic areas. (b) Linearhypoechoic area seems to extend from the endometrial lining into the scar, raising the suspicion of myometrial scar dehiscence, however serosa is clearly intact.
[Table/Fig-3]:
[Table/Fig-3]:
(a-d) – Image showing CT/MRI pictures, with varying degrees of uterine wound disruption along with haematomatous/septic collection; with respective surgical findings for correlation. (a) CT scan of abdomen sagittal image showing a linear hypodense area (arrow) noted in the lower uterine segment extending from the endometrial cavity till the serosal surface s/o complete dehiscence along with ascites. On laparotomy, uterine scar was found inflamed, sloughing till serosa. However, no dehiscence demonstrated. (b) MRI pelvis coronal post contrast image (patient with secondary postpartum hemorrhage) showing focal breach in the endometrium and myometrium (black arrow) along right lateral aspect with intact serosa (double arrow) suggesting scar dehiscence, however no peritoneal fluid/ haematoma in uterovesical pouch. On laparotomy, a 2 cm rent was seen in the uterine scar from which pus, blood clots and debris were extruding, serosa intact. (c) Plain CT of pelvis showing a large well defined haematoma (arrows) anterior to the body of the uterus with no breech in myometrium. However in view of large haematoma, partial serosal side dehiscence was considered. On surgery, uterine wound was intact. Haematoma found in the uterovesical region and 300 gm of clot has been evacuated. (d) Abdominal CT showing focal hypodense area reported as possibly dehiscence in uterine scar (red arrows) with indistinct serosal lining however no haematoma anterior to uterus. Uterine scar was found to be necrotic, thin and sloughing, however showed no area of dehiscence on laparotomy.
See this image and copyright information in PMC

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