Rahmatika Nadya, Wirjopranoto Soetojo, Azmi Yufi Aulia, Soetojo Bagus Wibowo, Putra Antonius Galih Pranesdha, Soetanto Kevin Muliawan
Faculty of Medicine, Wijaya Kusuma University, Surabaya, Indonesia.
Department of Urology, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Int J Surg Case Rep. 2025 Jul;132:111494. doi: 10.1016/j.ijscr.2025.111494. Epub 2025 Jun 9.
Acute abdomen after section cesarean (SC) is a case that can occur, and the diagnosis of the cause is very challenging. This case report describes the immediate diagnostic and management of unspecified abdominal pain on Day 13th post-SC, accompanied by complications.
A 30-year-old woman with a history of SC on the 13th day came to the Emergency Room (ER) with abdominal pain and decreased consciousness. Focused Assisted Sonography in Trauma (FAST) and Kidney Ureter Bladder (KUB) X-ray as a diagnostic tool was performed, followed by laparotomy as definitive management. We found a 7 cm bladder rupture in the bladder dome, 8 L of urine mixed with pus, and 300 cc of blood clots. We manually evacuated the urine and blood clots and refreshed the bladder tissue and cystostomy, and then the bladder was sutured. Double antibiotics were given for Staphylococcus hemolyticus infection.
The diagnosis of abdominal pain was challenging. Late diagnosis can cause complications and mortality. FAST and KUB X-rays are useful tools in the care of bladder rupture after SC. Laparotomy is an option for treatment. In this case, the patient underwent laparotomy followed by cystostomy. The role of double antibiotics is necessary in cases of sepsis.
Patients with unspecified abdominal pain after SC need immediate diagnosis. Diagnosis with FAST is sufficient to be done in unstable patient conditions. Immediate management with Laparotomy and Cystostomy combined with antibiotics can minimize mortality.
剖宫产术后急腹症是一种可能发生的情况，病因诊断极具挑战性。本病例报告描述了剖宫产术后第13天不明原因腹痛的即时诊断与处理，伴有并发症。
一名有剖宫产史的30岁女性在术后第13天因腹痛和意识减退来到急诊室。采用创伤重点辅助超声检查（FAST）和肾脏输尿管膀胱（KUB）X线检查作为诊断工具，随后进行剖腹手术作为确定性治疗。我们发现膀胱顶部有一个7厘米的膀胱破裂，有8升尿液与脓液混合，还有300立方厘米的血凝块。我们手动清除了尿液和血凝块，修复了膀胱组织并进行了膀胱造口术，然后缝合了膀胱。针对溶血葡萄球菌感染给予了双重抗生素治疗。
腹痛的诊断具有挑战性。延迟诊断可导致并发症和死亡。FAST和KUB X线检查是剖宫产术后膀胱破裂护理中的有用工具。剖腹手术是一种治疗选择。在本病例中，患者接受了剖腹手术及随后的膀胱造口术。在败血症病例中，双重抗生素的作用是必要的。
剖宫产术后不明原因腹痛的患者需要即时诊断。在患者病情不稳定的情况下，进行FAST诊断就足够了。立即进行剖腹手术和膀胱造口术并联合使用抗生素可将死亡率降至最低。
