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Uterine Dehiscence

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This is a CTA of the abdomen and pelvis.

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in a patient two days status post

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cesarean section presenting with acute

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onset abdominal pain and discomfort.

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On the left, we have arterial phase images and

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on the right, we have the venous phase images.

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As we scroll inferiorly, we begin to see the

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enlarged postpartum uterus come into view.

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This is normal myometrial vascularity

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that we see in the arterial phase.

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The endometrial cavity is distended with

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largely unenhancing blood products, in

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addition to some gas within the endometrial

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cavity, which is a normal finding in

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a patient in the postpartum period.

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As we scroll inferiorly, in addition to

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the gas within the endometrial cavity, we

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also see several locules of air extending

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anteriorly within the uterine myometrium

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and toward the level of the uterine serosa.

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There's air within the urinary bladder,

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which is likely due to instrumentation

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of the patient's Foley catheter.

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These are sagittal contrast-enhanced CT

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images of the pelvis for the same patient.

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Arterial phase images are on the left

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and venous phase images on the right.

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Again, we see a mildly enlarged postpartum

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uterus with distention of the endometrial

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cavity with blood products and gas.

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We see a defect in the lower uterine

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segment where there's tissue edema and

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focal disruption of the myometrium, which is

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consistent with the cesarean section site.

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However, we also see translocation of

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several of these locules of gas that are

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within the endometrial cavity through

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the cesarean section scar defect and

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toward the level of the uterine serosa.

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These are coronal contrast-enhanced CT

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images of the pelvis for the same patient.

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Again, the arterial phase images are on the left

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and the venous phase images are on the right.

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Again, we see distention of the endometrial

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cavity with gas and blood products.

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However, we see several areas where

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there is linear translocation of gas

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from the endometrial cavity through the

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myometrium and toward the uterine serosa.

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Because of these findings, a diagnosis of

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postoperative uterine dehiscence was suggested.

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The patient was hemodynamically stable

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and was managed successfully with uterine

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massage in the early postpartum period.

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Uterine dehiscence is defined as

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separation of the endometrium from the

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myometrium with intact uterine serosa.

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Remember that in the previous case that

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we showed, there was extension of gas

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from the endometrial cavity through the

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myometrium, but not through the uterine serosa.

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Uterine dehiscence is distinct from

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uterine rupture, which includes

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extension through the uterine serosa.

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CT is the imaging modality of choice

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for the evaluation of suspected uterine

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dehiscence in the postpartum period.

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Uterine dehiscence is a dangerous

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clinical entity and can contribute to

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significant postpartum hemorrhage, so

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prompt diagnosis and management are key.

Report

Faculty

Erin Gomez, MD

Assistant Professor of Radiology

Johns Hopkins Hospital

Tags

Women's Health

Uterus

Gynecologic (Gyn)

Gynecologic (GYN)

Genitourinary (GU)

Cervix

CT

Body

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