a post LScs complication

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

1. 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

2. 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

3. 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.

4. 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

5. 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

6. 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%)