Delayed presentation of vernix caseosa peritonitis

Chambers, AC; Patil, Abhinandan; Alves, Rui; Hopkins, JC; Armstrong, John G.; Lawrence, R

doi:10.1308/003588412x13373405385296

Cited by 9 publications

(12 citation statements)

References 9 publications

(9 reference statements)

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“…Cases of postcaesarean peritonitis in the literature describe uncommon infective organisms including Candida [8] and Streptococcus pneumoniae [9], along with noninfective etiologies such as reactive [10] and vernix caseosa [11] peritonitis. Similar cases of uterine dehiscence complicated by peritonitis have varied clinical presentations including fever, abdominal pain, distension, vaginal discharge, wound infection [12], and PPH [13].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Watery Vaginal Discharge due to Caesarean Scar Dehiscence following Brace Suture and Balloon Tamponade for the Management of Postpartum Hemorrhage

Koh

Devendra

Kathirvel

2020

Case Reports in Obstetrics and Gynecology

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A woman in her early twenties with dichorionic diamniotic twins underwent emergency caesarean section (CS) for failed induction of labor for discordant growth at 37 weeks. Her CS was complicated by atonic postpartum hemorrhage (PPH) requiring uterotonics, B-lynch suture, and Bakri balloon. She presented on the 5th postoperative day (POD) with fever and wound pain and collapsed due to desaturation. Investigations confirmed ascites on computed tomography (CT) of her abdomen and cardiomyopathy on echocardiogram. She was readmitted on the 22nd POD with watery vaginal discharge. CT abdomen revealed a dehisced CS scar and loculated ascites. Her discharge settled after three weeks with antibiotics and drainage of the ascites. A CT scan 3 months later showed reduction of the peritoneal collection. Caesarean scar dehiscence should be considered for patients presenting with ascites and vaginal discharge after a CS, particularly in the presence of risk factors such as infection or anemia.

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Section: Discussionmentioning

confidence: 99%

A Rare Case of Watery Vaginal Discharge due to Caesarean Scar Dehiscence following Brace Suture and Balloon Tamponade for the Management of Postpartum Hemorrhage

Koh

Devendra

Kathirvel

2020

Case Reports in Obstetrics and Gynecology

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“…However, some cases of VCP develop in primiparous women suggesting that hypersensitivity reaction is less likely. The main symptoms of VCP are generalized severe abdominal pain, pyrexia, peritonism, and neutrophilic leukocytosis within 3 to 35 days following cesarean section (11,12). The imaging techniques show non-specific changes or are normal.…”

Section: Discussionmentioning

confidence: 99%

“…That treatment was a preference of the obstetrician. Some authors have advocated postoperative antibiotic therapy (5)(6)(7)(11)(12)(13), and even adjuvant steroid therapy in cases with resistant symptoms when infection has been excluded (6). However, these treatments remain empirical and controversial since none of them are really evidencebased (2).…”

Section: Discussionmentioning

confidence: 99%

Vernix caseosa peritonitis: report of two cases

Val-Bernal¹,

Mayorga²,

García-Arranz³

et al. 2014

TJPATH

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Vernix caseosa peritonitis is a rare complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity. Most cases occur after cesarean section. We discuss herein two patients, aged 33 and 29 years, who presented with vernix caseosa peritonitis seven to nine days after a cesarean delivery. Laparotomy was performed and it revealed neither uterine rupture nor other surgical emergencies, but cheesy exudates on the serosal surface of all viscera. Appendicectomy was performed. Histopathologic study revealed acute fibrinous serositis and a mixed cellular infiltrate, rich in neutrophils, around fetal desquamated anucleate squamous cells. Patients´ recovery was complete. Clinical diagnosis of vernix caseosa peritonitis should be suspected in patients presenting post-cesarean section with an acute abdomen. Distinctive histopathologic findings allow making the correct diagnosis. Vigilant monitoring after diagnosis is essential as delayed morbidities may appear.

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“…Some authors have advocated postoperative antibiotic therapy 4–6,8,11,15. Adjuvant steroid therapy was used in two cases with resistant symptoms when infection has been excluded 8.…”

Section: Discussionmentioning

confidence: 99%

“…13 All the cases reported occurred after cesarean section. 1–18 The previous publications in this field were identified by PubMed Search using the search words “vernix”, “caseosa”, “peritonitis”, “diagnosis”, and “management.” Only three cases have been reported, which had their onset of symptoms from the antenatal period. 7,11 The other cases were diagnosed in the postpartum period after uneventful cesarean section.…”

Section: Introductionmentioning

confidence: 99%

Vernix Caseosa Peritonitis after Vaginal Delivery

Sadath¹,

Diba²,

Nayak³

et al. 2013

Clin Med Insights Case Rep

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IntroductionVernix caseosa peritonitis (VCP) is a very unusual complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity. Twenty-seven cases have been reported, and all occurred after cesarean section.Case presentationWe present a case of VCP following vaginal delivery; this may be the first case reported after vaginal delivery. Mrs. A, 28 years old, gravida 3, para 2, with one previous cesarean section, was admitted at 41 weeks gestation in active labor. Vacuum extraction was performed to deliver a healthy male baby, 4.410 kg, Apgar scores 7, 8. She developed fever, acute abdominal pain, and distension about 3 hours after delivery. A diagnosis of acute abdomen was made. Laparotomy was performed and it revealed neither uterine scar rupture nor other surgical emergencies, but 500 mL of turbid fluid and some cheesy material on the serosal surface of all viscera. Biopsies were taken. She had a course of antibiotics and her recovery was complete. Histology of the peritoneal fluid and tissue biopsy resulted in a diagnosis of VCP.ConclusionClinical diagnosis of peritonitis due to vernix caseosa should be considered in patients presenting postpartum with an acute abdomen after vaginal delivery.

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Delayed presentation of vernix caseosa peritonitis

Cited by 9 publications

References 9 publications

A Rare Case of Watery Vaginal Discharge due to Caesarean Scar Dehiscence following Brace Suture and Balloon Tamponade for the Management of Postpartum Hemorrhage

A Rare Case of Watery Vaginal Discharge due to Caesarean Scar Dehiscence following Brace Suture and Balloon Tamponade for the Management of Postpartum Hemorrhage

Vernix caseosa peritonitis: report of two cases

Vernix Caseosa Peritonitis after Vaginal Delivery

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