Multi-visceral fistula following Ceasrian section

Saba Sohail, Rabia Hafeez


A young married second para lady with known valvular heart disease and hepatitis C, presented with foul smelling pus- discharging sinus from previous caesarean section scar and fever since 20 days. X-ray sinogram was asked which showed complex fistula communicating with distal ileal loops and uterine cavity. Exploratory laparotomy showed an infected retained surgical swab, and uterine perforation along with gangrene of the descending colon and ileum. The foreign body was removed with gut resection and ileostomy. The postoperative course was marked by one episode of wound dehiscence. Distal loopogram after 6 months showed healed bowel loops without any fistulous communication. Ileostomy was then reversed and patient was discharged in stable state with advice for cardiology and hepatology referrals. 

KEY WORDS:- Abdominal wall sinus, retained gauze, bowel gangrene, complex fistula, caesarian section, complication.

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