Vernix Caseosa Peritonitis after Vaginal Delivery

Sadath, Shameema Anvar; Diba, Fathiya I. Abo; Nayak, Satheesha B; Shamali, Iman Al; Diejomaoh, Michael

doi:10.4137/ccrep.s12771

Cited by 10 publications

(11 citation statements)

References 13 publications

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“…Imaging generally yields inconclusive results, including normal tissues, fluid accumulation in the peritoneal cavity, or possible abscesses or nodules [3,[7][8][9][11][12][13]15,16,24]. Failure of pain resolution commonly leads to a laparotomy or laparoscopy to further investigate the source of ailment [17,[20][21][22][23][24][25]. The typical macroscopic appearance of VCP is of widespread white cheesy exudates on the serosal surfaces of multiple viscera.…”

Section: Discussionmentioning

confidence: 99%

Vernix Caseosa Peritonitis Causing Acute Abdomen After Cesarean Section: A Case Series

et al. 2022

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Objective:Rare disease Background:Vernix caseosa peritonitis (VCP) is a rare complication that typically presents following an otherwise uneventful cesarean section. Leakage of vernix caseosa into the peritoneum is thought to elicit a granulomatous foreign body reaction. Symptoms can be similar to other acute abdominal conditions, and diagnosis is confirmed by intraoperative findings and histological examination. Peritoneal lavage with supportive measures is the mainstay of treatment and recovery. Case Reports:Case 1 was a 30-year-old woman who developed right iliac fossa pain, fever, tachycardia, and tachypnea less than a week after her lower segment cesarean section (LSCS). She underwent a laparoscopy for a peritonitic abdomen and concern for intra-abdominal sepsis. A peritoneal biopsy demonstrated histological changes consistent with VCP.Case 2 was a 39-year-old woman who underwent a LSCS. After discharge, she re-presented with generalized abdominal pain. With computed tomography (CT) scan findings suggestive of appendicitis, an appendectomy was performed, and vernix caseosa was detected in all quadrants.Case 3 was a 33-year-old woman who presented with fever, vomiting, diarrhea, and iliac fossa pain 9 days following an LSCS. She was given analgesia and antibiotics for a pelvic fluid collection noted on CT scan. She represented with tense swelling and pain above her cesarean section incision. Laparoscopy revealed adhesions over the lower abdomen and pelvis and white plaques suggestive of vernix caseosa along the peritoneal side walls. Conclusions:The rising incidence of cesarean births worldwide creates the potential for increased numbers of VCP cases.Greater recognition of VCP is warranted to prevent unnecessary procedures.

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Section: Discussionmentioning

confidence: 99%

Vernix Caseosa Peritonitis Causing Acute Abdomen After Cesarean Section: A Case Series

et al. 2022

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“…It is a rare peripartum condition and is thought to be secondary to the dribbling of fetal amniotic fluid into the maternal abdominal cavity. Typically, the amniotic fluid reaches the mother's abdomen during CS or from uterine perforation [2][3][4]; alternatively, it reaches by backflow from the uterus during vaginal delivery or prenatally [1,7]. The presence of the amniotic fluid into the maternal cavity initiates an inflammatory reaction and subsequent peritonitis [5].…”

Section: Discussionmentioning

confidence: 99%

“…Frequently, patients have signs and symptoms simulating acute abdomen: diffuse abdominal pain, distention; tenderness and rebound tenderness; fever (38.8°C); tachycardia (100-110/min) [6,[8][9]. Shortness of breath and ascites can be part of the clinical picture [1][2]4]. The laboratory workup may reveal only an elevation of white cell count.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous intraoperative findings were reported: a variant amount of bloody ascites, turbid fluids, yellowish plaques on the liver surface, extensive adhesions, fibrinous omental plaques, granulomatous inflammation, mass lesions resembling bowel perforation, and widespread white adhesive exudate covering the surface of the abdominal organs and parietal peritoneum. In most cases, no uterus or bowel perforation nor obvious intra-abdominal emergencies can be detected [1][2][3][4]6,[9][10].…”

Section: Discussionmentioning

confidence: 99%

“…VCP is hypothesized to be due to the dribble of the fetal amniotic fluid or meconium into the maternal abdominal cavity [2]. VCP is of interest because it presents as an acute abdomen within hours to weeks after a straightforward CS or vaginal delivery [3][4]. The greatest challenge is that the VCP is confused with the common causes of acute abdomen and is a leading cause of unnecessary exploratory laparotomy or laparoscopy and surgical removal of seemingly involved abdominal organs such as the appendix, ovary, Fallopian tubes, and colon; finally, these organs are proved to be normal on histopathology examination [5][6].…”

Section: Introductionmentioning

confidence: 99%

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Vernix Caseosa Peritonitis as a Rare Cause of Acute Abdomen After Cesarean Section

Danawar

ALmosalami

Elhadj

et al. 2021

Cureus

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Although Vernix caseosa peritonitis (VCP) is a rare complication of cesarean section (CS). It possesses a high rate of morbidity and its exact underlying pathology is not fully understood yet. However, it is assumed that the leakage of amniotic fluid into the maternal abdominal cavity triggers the inflammatory process. We discussed herein a 25-year-old patient who developed acute peritonitis three days after cesarean section. CT abdomen showed multiple fluid collections with no obvious other pathologies. At laparotomy, we found cheesy exudates covering the peritoneal surface of the abdominal viscera and multiple turbid fluid collections, but no bowel, uterine, or any another organ injury could be identified. Abdominal washing was done and, as the appendix was queried, an appendectomy was added. Histopathology study of the omental biopsy revealed mixed inflammatory infiltrate, fibrin, fetal hair, and squames. These findings suggest the diagnosis of VCP, but the removed appendix was normal. The postoperative course was long and complicated. A few cases of VCP were reported in the world; the majority of these cases are from the USA and a few are from the UK. According to the information we have, our case is the first reported case of VCP in Saudi Arabia. Typically, VCP is manifested as acute abdomen hours to weeks after CS or vaginal delivery. As VCP is usually mistaken for the other causes of acute peritonitis, and the diagnosis is only established by the histopathology examination of peritoneal or omental biopsies, the case is commonly managed by urgent laparotomy or laparoscopy with the removal of suspected organs, which are later confirmed to be normal on histopathology study. The typical intraoperative findings are adhesive exudate, white or cheeselike membranes covering the intraabdominal viscera, and fluid collections, but no visceral injuries can be identified. Therefore, it is crucial to include the VCP in the differential diagnosis of the acute abdomen after CS or vaginal delivery to avoid unnecessary laparotomy and removal of normal organs.

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