Vernix caseosa peritonitis presenting as a soft tissue mass

Area of Science:

• Obstetrics and Gynecology
• Surgical Pathology

Background:

• Vernix caseosa peritonitis (VCP) is a rare condition.
• It presents as non-necrotising granulomatous inflammation in the peritoneal cavity post-childbirth.
• VCP typically follows caesarean section (CS), with acute abdominal pain and fever, usually managed surgically.

Purpose of the Study:

• To report two cases of VCP presenting with abdominal masses.
• To evaluate conservative management for VCP.
• To highlight VCP as a potential underdiagnosed complication of CS.

Main Methods:

• Case report of two women presenting with abdominal masses 4 weeks post-elective CS.
• Diagnostic imaging included CT scan showing soft tissue mass and peritoneal thickening.
• Histological examination of biopsy confirmed non-necrotising granulomatous inflammation consistent with VCP.

Main Results:

• Both patients presented with abdominal masses and peritoneal thickening suspicious for infection or malignancy.
• Biopsy confirmed VCP in both cases.
• Both patients were successfully managed conservatively with full recovery.

Conclusions:

• VCP is a rare but potentially underdiagnosed complication following caesarean section.
• Consider VCP in patients with persistent abdominal pain post-CS, especially with palpable masses.
• Conservative management with biopsy for diagnosis may be a safe alternative to surgery in select patients.