J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website http://www.jcgo.org

Case Report

Volume 6, Number 3-4, October 2017, pages 65-70

Conservative Surgical Management of Uterine Incisional Necrosis and Dehiscence After Primary Cesarean Delivery Due to Proteus mirabilis Infection: A Case Report and a Review of Literature

Figure 1. CT scan of the abdomen and pelvis with intravenous and oral contrast showing an intramyometrial gas formation, a collection of 5 × 3 × 3 cm anterior to the uterine scar and a second collection of 5 × 4 × 3 cm in the Douglas pouch.

Figure 2. Exploratory laparotomy. (a) Ruptured uterine scar and infected necrotic edges. (b) Debridement of the uterine scar edges.

Figure 3. Two consecutive sagittal views on T2-weighted MRI of the pelvis showing an intact uterine serosa (black arrows), a normal endometrial thickness and a small indentation at the level of the uterine scar (white arrow).

**Table 1.** The Presentation and the Outcome of 23 Patients Having Infected Uterine Incisional Necrosis and Dehiscence Found in the English Literature
Case	Presentation	Onset of symptoms after delivery	Hysterectomy	Culture
NA: not available.
1 [3]	Wound infection; fever	15 days	Yes	NA
2 [4]	Fever	2 days	No	Escherichia coli
3 [5]	Wound infection; fever	7 days	No	Staphylococcus aureus
4 [6]	Vaginal discharge	15 days	Yes	NA
5 [7]	Abdominal pain; fever	9 days	Yes	Escherichia coli
6 [8]	Heavy vaginal bleeding	10 weeks	Yes	Escherichia coli
7 [9]	Abdominal wall dehiscence	3 days	No	Streptococcus anginosus
8 [10]	Abdominal pain; fever	15 days	No	NA
9 [11]	Abdominal pain; fever	8 weeks	No	Staphylococcus aureus
10 [12]	Heavy vaginal bleeding	6 weeks	Yes	NA
11 [13]	Heavy vaginal bleeding	11 days	No	Corynebacterium sp, Prebotella bivia
12 [14]	Wound infection; vomiting	6 days	No	Staphylococcus, Enterococci
13 [14]	Abdominal pain; fever; vomiting	10 weeks	No	Escherichia coli
14 [14]	Wound infection; fever; nausea	12 days	Yes	Staphylococcus aureus
15 [15]	Abdominal pain; fever	3 days	Yes	NA
16 [15]	Abdominal pain; fever	3 days	Yes	NA
17 [15]	Abdominal pain; fever	3 days	Yes	NA
18 [15]	Abdominal wall dehiscence	5 days	Yes	NA
19 [15]	Heavy vaginal bleeding	6 weeks	Yes	NA
20 [16]	Abdominal pain; vomiting	8 weeks	No	NA
21 [17]	Abdominal pain	5 days	Yes	Pseudomonas aeruginosa, Staphylococcus, Citrobacter roseri
22 [18]	Heavy vaginal bleeding; fever	14 days	Yes	NA
23 [19]	Heavy vaginal bleeding	6 weeks	Yes	NA
The present case	Abdominal pain; fever	10 days	No	Proteus mirabilis

Table 1. The Presentation and the Outcome of 23 Patients Having Infected Uterine Incisional Necrosis and Dehiscence Found in the English Literature

Case

Presentation

Onset of symptoms after delivery

Hysterectomy

Culture

NA: not available.

1 [3]

Wound infection; fever

15 days

Yes

2 [4]

Fever

2 days

Escherichia coli

3 [5]

Wound infection; fever

7 days

Staphylococcus aureus

4 [6]

Vaginal discharge

15 days

Yes

5 [7]

Abdominal pain; fever

9 days

Yes

Escherichia coli

6 [8]

Heavy vaginal bleeding

10 weeks

Yes

Escherichia coli

7 [9]

Abdominal wall dehiscence

3 days

Streptococcus anginosus

8 [10]

Abdominal pain; fever

15 days

9 [11]

Abdominal pain; fever

8 weeks

Staphylococcus aureus

10 [12]

Heavy vaginal bleeding

6 weeks

Yes

11 [13]

Heavy vaginal bleeding

11 days

Corynebacterium sp, Prebotella bivia

12 [14]

Wound infection; vomiting

6 days

Staphylococcus, Enterococci

13 [14]

Abdominal pain; fever; vomiting

10 weeks

Escherichia coli

14 [14]

Wound infection; fever; nausea

12 days

Yes

Staphylococcus aureus

15 [15]

Abdominal pain; fever

3 days

Yes

16 [15]

Abdominal pain; fever

3 days

Yes

17 [15]

Abdominal pain; fever

3 days

Yes

18 [15]

Abdominal wall dehiscence

5 days

Yes

19 [15]

Heavy vaginal bleeding

6 weeks

Yes

20 [16]

Abdominal pain; vomiting

8 weeks

21 [17]

Abdominal pain

5 days

Yes

Pseudomonas aeruginosa, Staphylococcus, Citrobacter roseri

22 [18]

Heavy vaginal bleeding; fever

14 days

Yes

23 [19]

Heavy vaginal bleeding

6 weeks

Yes

The present case

Abdominal pain; fever

10 days

Proteus mirabilis