Maternal sepsis due to Bacteroides fragilis: a case report and review of the literature.

BACKGROUND: Sepsis remains a leading and potentially preventable direct cause of maternal mortality globally. Pelvic abscess following caesarean section is an uncommon complication of surgical site infection leading to maternal sepsis especially in developed countries and can present a diagnostic dilemma especially in the absence of fever. It is rare for it to develop within 5 days following surgery. Our case demonstrates that early recognition and prompt treatment of maternal sepsis in women with atypical presentation is key to successful clinical outcome.

CASE PRESENTATION: We present an unusual case of a 37-year-old Indian female patient who presented 5 days after caesarean section with severe abdominal pain, constipation, and urinary retention. On examination, she was afebrile but had tachypnea, tachycardia, and decreasing blood pressure. Her abdomen was markedly tender with guarding and rebound tenderness. Her serum lactate was 2.7 mmol/L. Sepsis was recognized through the Qatar early warning system, systemic inflammatory response syndrome scores, and abnormal laboratory values in the setting of infection. A computed tomography scan of her abdomen showed uterovesical abscess (a rare form of pelvic abscess). After stabilizing with a Sepsis Six bundle, an urgent laparotomy for abscess drainage and peritoneal lavage was performed. The culture of blood and abscess grew profuse Bacteroides fragilis. She made a rapid postoperative recovery and was discharged after 4 days.

CONCLUSION: This case highlights the fact that early recognition of maternal sepsis, even in the absence of fever; prompt and appropriate antibiotic treatment; source control; escalation of care; and monitoring are crucial to reducing maternal morbidity and mortality. Our case demonstrates how delay was avoided in recognition, source control, and escalation of care, and current literature was comprehensively reviewed.