Panniculectomy as a surgical option for the management of a deep surgical site infection after C-section in a morbidly obese woman: a case report.

Abstract

Background: Obesity is an independent risk factor for the occurrence of surgical site infections (SSIs) following all types of surgeries, especially after Caesarean section (C-section). SSIs increase postoperative morbidity, health economic cost and their management is quiet complex with no universal therapeutic consensus. Herein, we report a challenging case of a deep SSI after C-section in a central morbidly obese woman managed successfully by panniculectomy.

Case presentation: A 30-year-old black African pregnant woman with marked abdominal panniculus extending to the pubic area, a waist circumference = 162 cm and BMI = 47.7 kg/m² underwent an emergency CS indicated for acute fetal distress. By day five post-operation, she developed a deep parietal incisional infection unremitting to antibiotic therapy, wound dressings and beside wound debridement till the 26th postoperative day. A large abdomen panniculus and maceration of the wound enhanced by central obesity increased the risk of failure of spontaneous closure; thus, an abdominoplasty by panniculectomy was indicated. The patient underwent panniculectomy on the 26th day after the initial surgery and her post-operative course was uneventful. Wound esthetics was satisfactory three months later. Adjuvant dietary and psychological management were associated.

Conclusion: Post-Caesarean deep SSI is a frequent complication in obese patients. A panniculectomy may be a safe and promising therapeutic surgical option with good cosmetic results and little postoperative complications when used in a multidisciplinary anti-obesogenic approach.