Management of post-cesarean pelvic abscess in the uterine scar: A case report and mini-review of the literature.

Cesarean section is among the most frequently performed surgical procedures worldwide. In recent years, the increasing rate of cesarean deliveries has led to an increased incidence of post-operative complications. The present case report describes a rare case of a post-operative pelvic abscess located at the uterine scar following a cesarean section, managed successfully via laparotomy. The patient, a 17-year-old woman, was admitted 1 week after undergoing a cesarean delivery. She presented with abdominal pain, fever and chills. Blood tests revealed elevated inflammatory markers and a mild coagulation disorder, consistent with an ongoing infectious process. The results of urinalysis did not reveal any notable findings. A transvaginal ultrasound and an abdominal computed tomography scan revealed a large, mixed echogenic mass with irregular borders and the presence of intralesional air bubbles, localized at the uterine scar anterior to the bladder. Given the persistence of clinical symptoms, supportive imaging and laboratory findings, and the failure of conservative management of the post-operative intra-abdominal infection, surgical intervention was deemed necessary. A laparotomy was performed through the previous cesarean incision. Intraoperatively, an abscess was identified at the site of the uterine scar and was surgically drained. Samples were collected for aerobic and anaerobic cultures, and the cavity was irrigated thoroughly to remove purulent and hemorrhagic material. A drainage tube was placed before closure. The postoperative course of the patient was uneventful, with complete clinical resolution. Following the case presentation, a brief review of the current diagnostic and therapeutic strategies for this uncommon post-operative complication is also provided. On the whole, the present case report underscores the importance of timely surgical intervention via laparotomy when image-guided drainage or laparoscopy is not feasible.