my patient went elective lscs and later presented with pus in abdominal cavity

2. My patient mrs X came to Bharati hospital referred from a
private hospital on (0+19) post-operatrive day of LSCS with c /o
• Pain in abdomen
• Abdominal distension
• Difficulty in passing urine and motion since the day of surgery
• She also gives history of fever on and off since 8 days

3. • She underwent LSCS + TL on 30/7/2020 in view of previous
LSCS and CPD surgery was uneventful->she was discharged
on (0+3) POD (3/8/20)
• LSCS suture was removed on (0+10) POD with healthy scar
and well involuting uterus.
• Patient presented to a local doctor on (0+10) Pod of LSCS with
c / pain in abdomen, abdominal distension, weakness and
incomplete evaculation of bowel& bladder and on & off fever
since 8 days

4. • Her USG was done which showed e /o intraabdominal
,intraperitoneal collection in the pelvic region with normal
abdominal organs.
• She was admitted for her above complaints at Sutika seva
hospital and was managed conservatively
• She was given IV fluids (1500ml) in view of persistent Low BP
(90/60mmhg) and INJ Lasix 20mg iv in view of decreased urine
output and was transferred to a tertiary care hospital.

5. • Patient was referred from sutika seva on 18/8/20.
• On examination-
• Patient was conscious, afebrile
• BP -100/60mmhg , PR- 114/min, spo2- 98% on Room air
• Cvs /RS –NAD
• P/a- distended,local rise of temperature present, guarding+,
rigidity+,Bowel sounds- absent, AG -90cm
• LE- Foleys insitu
• PV-NAD

6. • Patient was started on IVF and shifted for MSCT
• MRCT was s /o Hypodense loculated collection in the pelvis ,lower abdomen, upper
abdomen and upper abdomen in lower perihepatic region. Peripherally enhancing
collection in pelvis,lower abdomen & upper abdomen in lower perihepatic region
involving lower anterior abdominal wall s /o infected ascites /intraperitoneal
abscess.
• Mild free fluid in the mesenteric sleeves, left subdiaphragmatic region & left
paracolic gutter
• Approximate size of lower intraperitoneal collection was around 800 -1400cc & of
lower anterior abdominal wall collection was around 80 -120cc
• Uterus showed postpartum status

7. • Patient was shifted to ICU for further management & was started on IV
antibiotics for the same (INJ Targocid 400mg bd and INJ meropenem 500mg
tds)
• USG guided PIGTAIL insertion was done on 19/8/20 on (0+19 POD of
LSCS),and around 20cc dark coloured fluid was aspirated which was sent for
culture & sensitivity
• Patient was monitored in the ICU ,She developed fever on and off and was
managed accordingly for the same with antipyretics and antibiotics .
She was given 1 pcv in view of anaemia (HB 7.7 gm%)