Abdominal pain in a postpartum patient

Acute abdominal pain is a very common presenting complaint in the Emergency Department (ED). Making the correct diagnosis may be very complicated and difficult. It is even more difficult and complicated in the postpartum period, because other less common but important diagnoses must be considered. One of these potentially life-threatening diagnoses for which patients should be evaluated is uterine rupture.

To discuss uncommon, but important, causes of abdominal pain that may occur in the postpartum period. To learn the clinical presentation, risk factors, evaluation, and management of uterine rupture in the postpartum patient.

We present the case of a 36-year-old woman who presented to the ED with 2 days of abdominal pain and fever. The patient had had a caesarian section (C-section) 2 weeks before this admission. This was her fourth C-section. On examination, she had right lower quadrant tenderness. A computed tomography scan of the abdomen with contrast was obtained and it revealed uterine perforation with an adjacent abscess. The patient received intravenous fluids and broad-spectrum antibiotics. A laparotomy was performed that confirmed the diagnosis of uterine perforation. The patient subsequently did very well.

Uterine perforation should be considered in any postpartum patient that presents with acute abdominal pain, especially if there are risk factors, such as previous C-sections. Appropriate evaluation, consultations, and management should be done expeditiously to avoid increased morbidity and mortality.