Small bowel herniation through a caesarean section wound presenting as cellulitis: A case report

Small bowel herniation through a Caesarean section wound is exceedingly rare and may present with erythema and induration clinically indistinguishable from superficial wound infection, risking dangerous diagnostic delay. A case is reported here of a 39-year-old woman with one prior Caesarean section and a body mass index of 30 kg/m² who underwent elective lower segment Caesarean section at 39 weeks of gestation, complicated by intraoperative adhesiolysis and decompression of a uterovesical fatty cyst. On postoperative day 3, the patient re-presented with right iliac fossa pain, vomiting, and extensive blanching erythema extending to the right anterior superior iliac spine. The wound appeared clean and intact; the patient remained apyrexial with markedly elevated inflammatory markers. Initial assessment suggested cellulitis. Computed tomography of the abdomen and pelvis revealed herniation of the small bowel through the Caesarean section wound with early obstructive features. Examination under anaesthesia confirmed small bowel herniating through a rectus divarication with proximal distension. Hydrodissection and adhesiolysis enabled complete reduction; colorectal inspection confirmed viable bowel throughout; no resection was required. Omental patching and layered fascial repair were performed. The patient was discharged on postoperative day 4 without complications. The authors could find only four reports of similar cases of small bowel herniation through a Caesarean section wound; a structured series of all five reported cases is presented. Postoperative wound erythema accompanied by gastrointestinal symptoms warrants urgent computed tomography imaging to exclude bowel herniation. Early operative intervention before ischaemia develops avoids the need for bowel resection. Multidisciplinary management encompassing obstetrics, radiology, and colorectal surgery is essential; later presentations in the existing literature are consistently associated with bowel necrosis and the need for resection.