IS Case 101: Post-cesarean Surgical Site Infection/Abscess

A. R. Klekers, MD


Imaging Sciences URMC 2008
Publication Date: 2009-05-20

History

A 31 year-old-woman with fever and incisional drainage postoperative day #7 status from c-section.

Findings

Rim enhancing low attenuation fluid collection containing air anterior to a postpartum uterus with defect in anterior wall secondary to c-section.

Diagnosis

Postcesarean Surgical Site Infection/Abscess

Discussion

In cases of pelvic abscess, patients most commonly present with fever, chills; abdomen pain; increased heart rate, decreased blood pressure if septic. Typically postoperative abscesses present in the intraperitoneal spaces such as the cul-de-sac, Morison pouch, and subphrenic spaces. There is overall 80% success rate when treating with percutaneous drainage. Best candidates for percutaneous drainage are those with fluid-filled abscesses >3 cm. Contraindications for drainage include coagulopathies, gas forming infections, soft tissue infection, or no safe route for drain placement. On CT abscesses typically appear as low attenuation fluid collections with gas in 50% of cases. After contrast enhancement there is peripheral rim enhancement. Multiple studies have disagreed on the risk factors for surgical site infection post c-section. Chorioamnionitis and preoperative remote infections significantly increase risk for post-operative infection.

References

  1. Benoist S, Panis Y, Pannegeon V, et al. Can failure of percutaneous drainage of postoperative abdominal abscesses be predicted? Am J Surg. 2002 Aug;184(2):148-53. [PMID: 12169359]
  2. # Tran TS, Jamulitrat S, Chongsuvivatwong V, Geater A. Risk factors for postcesarean surgical site infection. Obstet Gynecol. 2000 Mar;95(3):367-71. [PMID: 10711546]

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