Vernix caseosa peritonitis

Vernix caseosa peritonitis (VCP) is a rare and serious complication of caesarean section. It is thought to occur as a result of spillage of amniotic fluid and or meconium into the maternal peritoneal cavity at caesarean section. It manifests as an acute abdomen days to weeks after a seemingly uncomplicated caesarean section. Only 18 cases have been reported in the literature and all but one are from the USA. The pathophysiology is incompletely understood. In the past, the management of VCP included a laparotomy and removal of suspected abdominal organs which were invariably found to be normal on histopathological examination. However, the characteristic intraoperative finding was a cheesy white exudate that coats the visceral organs. The organs themselves were not inflamed. Histological examination of biopsy specimen of the cheesy exudates is the only way to make a diagnosis of VCP. This would reveal anucleate squamous cells along with lanugo hair and foreign body giant cell reaction. From recent case reports, peritoneal lavage appears to be the mainstay of treatment of VCP. Increased awareness of this condition is crucial so that it is considered in the differential diagnosis of post-caesarean acute abdomen thereby avoiding the unnecessary removal of healthy intra-abdominal organs. This review article summarises the current state of knowledge on VCP.