Interactive Transcript
0:01
So this is actually the same patient.
0:03
She represented or was admitted
0:05
and came for a CT scan a day or so
0:08
later because she wasn't improving.
0:09
She still had a postpartum fever, even though
0:12
she was being treated for endometritis.
0:15
So they got a CT scan here,
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and I'll let you look.
0:18
Here is the beginning of the uterus up here.
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We have a fluid collection
0:21
starting right here as well.
0:26
And if you just look at these axial images, it
0:31
can be a little tricky to figure out exactly
0:32
what's going on in this particular patient.
0:35
We can definitely see some air in
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the endometrium that corresponds or
0:39
correlates with our ultrasound images.
0:41
We have a fluid collection anteriorly, and
0:43
I put this little arrow here because this
0:45
is probably the exact same fluid collection
0:47
that we were seeing on the ultrasound, and
0:49
you can see why you couldn't see it that
0:50
well because there's lots of air within it.
0:53
But one thing I like to say is whenever
0:54
you're looking at a uterus-type of
0:56
problem on a CT scan, axial is really
0:59
not going to be your best friend.
1:00
I go to the sagittal.
1:02
So if we go to the sagittal
1:03
sequence on this patient,
1:07
again, you can see an enlarged uterus,
1:09
which we expect she is postpartum
1:11
slightly below the umbilicus, so maybe
1:13
a little bit larger than we expect.
1:15
Endometrium is going to be right here.
1:17
You can see there are foci of gas within it.
1:19
leading right out to the C-section scar.
1:21
We expect the C-section to be right around
1:23
here, and we see that it's full of air.
1:26
That probably isn't normal.
1:28
The other thing that you can see is if
1:30
you follow these foci of gas, they come
1:33
right out into this fluid collection.
1:35
And so this is a dehiscent C-section scar.
1:38
So she has endometritis.
1:39
She has dehiscence of her C-section scar.
1:42
And then this is her bladder right here, but
1:44
we have this gas-containing fluid collection.
1:48
Again, it all meets.
1:49
You can scroll up and down and see
1:50
these all meet gas-containing fluid
1:52
collection anterior to the uterus.
1:53
So she has an abscess.
1:55
So not only the endometritis,
1:56
she has an abscess.
1:58
And then to make things even worse, you
2:00
can see that there is a defect right here.
2:03
In the anterior abdominal wall through which
2:05
mesentery and small bowel loops have protruded.
2:08
So she has dehiscence of her endometrial
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scar in the uterus, I guess, which
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hadn't quite scarred yet, hadn't healed
2:15
dehisced, complicated by an abscess,
2:17
complicated by bowel dehiscence as well.
2:20
So this is uncommon.
2:23
Thankfully, this discontinuity can be
2:27
felt by physical exam on a bimanual exam,
2:29
but that's if the patient is going to be able
2:31
to tolerate that kind of pressure on them.
2:34
And then obviously this is
2:35
going to be a surgical repair.
2:36
This is not going to be a drained abscess.
2:38
This eviscerated bowel needs to be put back in.
2:40
This needs to be cleaned out and
2:43
this needs to be sewn back together.
2:45
So this is a rare complication from a C
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section birth, but something to keep in mind.
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It may not just be endometritis.
2:51
You have to think about dehiscence, abscess
2:53
formation, and at the worst, eviscerated bowel.
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These aren't going to be ultrasound diagnoses
2:58
necessarily, and you're probably going to
2:59
need CT imaging to put all of this together.
3:02
And that's what's going to happen when
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the clinical situation just doesn't match
3:06
with what is going on with the patient,
3:07
when they're not getting better when
3:08
they should with those IV antibiotics.
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