Danawar Nuaman A, ALmosalami Ihab A, El Amine Elhadj Olfa, Anis Raheel, Bubshait Ahmad
Department of General Surgery, Security Forces Hospital (SFHD), Dammam, SAU.
Department of Surgery, Security Forces Hospital (SFHD), Dammam, SAU.
Cureus. 2021 Sep 14;13(9):e17953. doi: 10.7759/cureus.17953. eCollection 2021 Sep.
Although Vernix caseosa peritonitis (VCP) is a rare complication of cesarean section (CS). It possesses a high rate of morbidity and its exact underlying pathology is not fully understood yet. However, it is assumed that the leakage of amniotic fluid into the maternal abdominal cavity triggers the inflammatory process. We discussed herein a 25-year-old patient who developed acute peritonitis three days after cesarean section. CT abdomen showed multiple fluid collections with no obvious other pathologies. At laparotomy, we found cheesy exudates covering the peritoneal surface of the abdominal viscera and multiple turbid fluid collections, but no bowel, uterine, or any another organ injury could be identified. Abdominal washing was done and, as the appendix was queried, an appendectomy was added. Histopathology study of the omental biopsy revealed mixed inflammatory infiltrate, fibrin, fetal hair, and squames. These findings suggest the diagnosis of VCP, but the removed appendix was normal. The postoperative course was long and complicated. A few cases of VCP were reported in the world; the majority of these cases are from the USA and a few are from the UK. According to the information we have, our case is the first reported case of VCP in Saudi Arabia. Typically, VCP is manifested as acute abdomen hours to weeks after CS or vaginal delivery. As VCP is usually mistaken for the other causes of acute peritonitis, and the diagnosis is only established by the histopathology examination of peritoneal or omental biopsies, the case is commonly managed by urgent laparotomy or laparoscopy with the removal of suspected organs, which are later confirmed to be normal on histopathology study. The typical intraoperative findings are adhesive exudate, white or cheese-like membranes covering the intraabdominal viscera, and fluid collections, but no visceral injuries can be identified. Therefore, it is crucial to include the VCP in the differential diagnosis of the acute abdomen after CS or vaginal delivery to avoid unnecessary laparotomy and removal of normal organs.
尽管胎脂性腹膜炎（VCP）是剖宫产（CS）的一种罕见并发症。但其发病率很高，确切的潜在病理机制尚未完全明确。然而，据推测羊水漏入母体腹腔会引发炎症过程。我们在此讨论一名25岁的患者，她在剖宫产术后三天出现急性腹膜炎。腹部CT显示有多个液性聚集区，无明显其他病变。剖腹手术时，我们发现腹部脏器的腹膜表面覆盖着干酪样渗出物以及多个浑浊的液性聚集区，但未发现肠道、子宫或其他任何器官损伤。进行了腹腔冲洗，由于怀疑阑尾有问题，遂加做了阑尾切除术。网膜活检的组织病理学研究显示有混合性炎性浸润、纤维蛋白、胎儿毛发和鳞屑。这些发现提示为VCP诊断，但切除的阑尾是正常的。术后病程漫长且复杂。世界上报道了少数几例VCP病例；其中大多数病例来自美国，少数来自英国。根据我们所掌握的信息，我们的病例是沙特阿拉伯首例报道的VCP病例。典型的VCP表现为剖宫产或阴道分娩后数小时至数周出现急腹症。由于VCP通常被误诊为急性腹膜炎的其他病因，且仅通过腹膜或网膜活检的组织病理学检查才能确诊，所以该病例通常通过紧急剖腹手术或腹腔镜检查并切除可疑器官来处理，而这些器官在组织病理学研究中后来被证实是正常的。典型的术中表现为粘连性渗出物、覆盖腹腔内脏器的白色或奶酪样膜以及液性聚集区，但未发现脏器损伤。因此，在剖宫产或阴道分娩后急腹症的鉴别诊断中纳入VCP至关重要，以避免不必要的剖腹手术和切除正常器官。
