Uterine dehiscence with abdominal gossypiboma

Case contributed by Dr Pir Abdul Ahad Aziz Qureshi

Presentation

Abdominal pain, fever. Prior lower segment cesarian section.

Patient Data

Age: 30 years
Gender: Female

The uterus is enlarged (S/P gravida) with dilated endometrium filled with the collection which is in continuity with the pre-uterine collection through a defect in the anterior lower uterine wall at the incision site representing uterine dehiscence with endometrial and pelvic collections. Few additional small pockets of collections are also seen in the pelvis and rectus abdominis muscle in the midline.

A large collection showing thick enhancing walls is seen in the left paracolic gutter. It shows mottled air lucencies and linear metallic density within it and is inseparable from the adjacent proximal small bowel loops. It is also abutting the descending colon and overlying muscles of the lateral abdominal wall. Findings are likely due to gossypiboma. 

Case Discussion

Emergency surgery was performed to repair the dehiscent uterine segment but unfortunately, it could not be done and therefore hysterectomy was performed. The collections were drained and gossypiboma was removed which was adherent to the small bowel loops.

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