Acute Generalized Post-Cesarean Peritonitis Complicated by Abdominal Gangrene at Conakry University Hospital: A Case Report

Purpose: To discuss the difficult diagnosis of a rare case of post-cesarean peritonitis complicated by abdominal wall gangrene. Case Report: Mrs. A.D, 25 years old, admitted on 9/24/2018 for fluid flow through the operative wound, abdominal pain, fever, cough. Evolution 6 days. Onset: edema, redness, blisters of the abdominal wall then fluid flow through the surgical wound of a cesarean section (breech presentation) at 38 weeks, performed on 9/15/2018 in a medico-communal center in Conakry. Patient readmitted on D6: abdominal necrosis+blisters: dressing of the operative wound, Ampicillin 1 g, Perfalgan 1 g then referred to visceral surgery at Donka National Hospital. No specific background. No known allergy. Use of dermocorticoids for skin depigmentation for the duration of 2 years. G2, P2, Cesarean section 1, Alive 1, Died 1. Patient conscious, hypocoloured in teguments and conjunctivae: BP=110/70 mm Hg, pulse=104/min, FR=24 cycles/min, temperature=37.8°C. Abdomen: wound extending from the hypogastrium up to 3 cm above the umbilical bone, also involving the flanks, with necrotic background+foulsmelling whitish pus. TV: vulva covered with sero-hematic secretions. Leukocytes 16 G/l Hb 9 g/l VS accelerated. At laparotomy: necrotic areas of the skin at the parietal peritoneum, discharge of 1 liter of foul-smelling purulent fluid. Then midline above and below umbilical incision connecting the transverse incision: deposits of fibrin throughout the cavity, intact uterine sutures: removal of fibrin. Peritoneal toilet. Aponeurotic approximation. Stripping of necrotic tissue. Parietal washing, dressing. Peritoneal fluid: Staphylococcus aureus, ceftriaxone 1 g IV twice a day. postoperative follow-up: iterative necrosectomies, complete healing on postoperative eventration. Conclusion: Possibility of post-cesarean peritonitis with progression to abdominal gangrene.