PMC5987234_01
Occurrence of hematoma after caesarean section and laparoscopic surgery to treat it. (a) Contrast CT image taken on the 3rd postoperative day. Hematoma of 9 cm in diameter existed at the isthmus of uterus. Red arrow indicates hematoma and uterus. (b) Contrast CT image taken on the 28th postoperative day. Hematoma of same size remained in the same place. Red arrow indicates hematoma and uterus. (c) MRI (T2-weighted image) findings of hematoma taken on the 28th postoperative day. Encapsulated hematoma existed. Red arrow indicates hematoma and bladder. (d) Intraoperative findings. Hematoma existed extraperitoneally, inside chorda umbilicalis. (e) We cut Cutting of peritoneum to reach inside of hematoma. Drainage tube was set.
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Performing an abdominal ultrasound examination and enhanced computed tomography (CT) of the lower abdomen, we found a hematoma with a diameter of 9 cm between the uterus and bladder (Figure 1). The hematoma was located extraperitoneally inside the chorda umbilicalis (Figure 1).
Treatment process and change of body temperature after emergent admission.
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Her fever still remained above 38 C (Figure 2), and her gastric discomfort tended to worsen each day. After the operation, her body temperature tended to decrease to below 37 C (Figure 2).
Imaging findings in the treatment of abscess and abscess position. (a) Enhanced CT image taken at the day of emergent admission. The density of abscess was relatively high, and air was detected. (b) Enhanced CT image taken at the 8th postadmission day. Abscess got large and reached to serosa of ileum. (c) Location of abscess is shown.
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Enhanced CT was performed and revealed that a cyst with a diameter of 9 cm was located at the same site where the hematoma had existed (Figure 3(a)). On the 9th postadmission day, we performed an enhanced CT scan and found an increase in abscess size (Figure 3(b)), which expanded into the peritoneal cavity, close to the ileocecal region. The abscess was mainly located in the obturator space surrounded by the bladder, uterus, ileum, and external iliac vein (Figure 3(c)).
MRI image taken 4 months after drainage operation. Abscess or cyst could not be detected.
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Four months after the operation, we performed a pelvic MRI examination and found no abnormal findings in her uterus, bladder, and pelvic space (Figure 4).