I have a 25 year old patient who underwent a Cesarean Section 3 weeks ago. Ever since the C-Section, she has been complaining of generalized abdominal pain and cough. Her ultrasound abdomen showed gross ascites. An ascitic tap was done and the fluid showed predominant lymphocytes. She was given some diuretics after which her ultrasound abdomen shows only minimal ascites. However she now has diarrhea. She still has generalized abdominal pain and cough. Her investigations showed mildly raised ESR and mildly raised ALT. Her mantoux, mycodot and chest x ray are clear. There was no indication of a sponge left in the abdomen on the ultrasound. Her abdomen is tender however there is no palpable mass. Her fever is 99-100 degrees Fahrenheit. Does anyone have any suggestions on how to proceed? Thank you for your help, in advance.
Could you please elaborate a bit more? Exactly what pathology should we be looking for/ruling out in the pelvic organs?
Many scenarios including peritonitis and septic shock start from endometritis. If you have systemic inflammatory process what antibiotics do you use?
Sometime chronic fasciolosis or hemonchucosis can course this type of clinical sign especial during pregnancy and immediately after birth. Therefore i will advice you to check her liver and do coprology test.
In the presence of ascites, it is not easy to exclude the existence of a forgotten foreign body. I think that if the patient's clinical condition does not improve, an exploratory laparotomy might be beneficial.
Difficult to diagnose a foreign body with ultrasound in the presence of ascites.
Did you exclude urinary tract injury? Was the serum creatinine raised?
how ascites disappearing with diuretics can be corelated? It is resolving chronic peritonotis.Tuberculor peritonitis triggered after surgical procedure is also second possibility.Peritoneoscopy will it be possible? find out.Last is exploratory laparotomy....
we should exclude urinary tract injury during cs with urinoma .also exclude missed towel by CT. exclude preexisting hepatic disease with postoperative deterioration and hepatitis by drugs or anaethetics. exclude post partum normotensive HELLP syndrome .ascites may be complicated by spontaneous a bacterial peritonitis with fever.excluding urinary tract injury and missed towel, antibiotics and plasma treatment and follow up for spontaneous resolution.
Exclude urinary track injury with streamup pyelography on both sides.
In case you have to deal with an urinoma leakage look at:
http://www.overtoomballoon.com/en_US/
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