Severe jaundice as presenting symptom of generalized peritonitis following cesarean section

Jaundice complicating severe bacterial infection has already been described; much less common is its occurrence as the presenting symptom of severe sepsis. A case is presented describing a patient who developed rapid increasing jaundice on the 4th day after an elective cesarean section, accompanied by deterioration in her general status. Various diagnostic means (abdominal CT, ultrasound investigation and hepatosplenic scanning) were performed in order to confirm or rule out the possibility of intraabdominal sepsis and the only finding on physical examination, being the absence of peristaltics. In spite of negative results of all the image processing techniques the patient underwent an explorative laparotomy on the 6th day, which revealed a generalized purulent peritonitis. It should be emphasized that: Severe jaundice maybe the presenting symptom of sepsis. False negative results of several modern image processing procedures may mislead the diagnostic approach and the subsequent therapeutic methods.