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Vernix caseosa peritonitis presenting as a soft tissue mass.

Laura Wharton1, Tessa Bonnett2, Emma Ferriman2

  • 1Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK laura.wharton@nhs.net.

BMJ Case Reports
|June 3, 2025
PubMed
Summary

Vernix caseosa peritonitis (VCP) is a rare childbirth complication. Conservative management with biopsy led to full recovery in two cases, suggesting it may be a safe option for stable patients.

Keywords:
Obstetrics and gynaecologyPregnancy

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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.