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Management of unspecified abdominal pain and its complications: A case reports
Nadya Rahmatika1, Soetojo Wirjopranoto2, Yufi Aulia Azmi3
1Faculty of Medicine, Wijaya Kusuma University, Surabaya, Indonesia.
Introduction And Importance:
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.
Case Presentation:
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.
Clinical Discussion:
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.
Conclusion:
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.
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