Vernix caseosa peritonitis

Vernix Caseosa Peritonitis as a Rare Cause of Acute Abdomen After Cesarean Section

Although Vernix caseosa peritonitis (VCP) is a rare complication of cesarean section (CS). It possesses a high rate of morbidity and its exact underlying pathology is not fully understood yet. However, it is assumed that the leakage of amniotic fluid into the maternal abdominal cavity triggers the inflammatory process. We discussed herein a 25-year-old patient who developed acute peritonitis three days after cesarean section. CT abdomen showed multiple fluid collections with no obvious other pathologies. At laparotomy, we found cheesy exudates covering the peritoneal surface of the abdominal viscera and multiple turbid fluid collections, but no bowel, uterine, or any another organ injury could be identified. Abdominal washing was done and, as the appendix was queried, an appendectomy was added. Histopathology study of the omental biopsy revealed mixed inflammatory infiltrate, fibrin, fetal hair, and squames. These findings suggest the diagnosis of VCP, but the removed appendix was normal. The postoperative course was long and complicated. A few cases of VCP were reported in the world; the majority of these cases are from the USA and a few are from the UK. According to the information we have, our case is the first reported case of VCP in Saudi Arabia. Typically, VCP is manifested as acute abdomen hours to weeks after CS or vaginal delivery. As VCP is usually mistaken for the other causes of acute peritonitis, and the diagnosis is only established by the histopathology examination of peritoneal or omental biopsies, the case is commonly managed by urgent laparotomy or laparoscopy with the removal of suspected organs, which are later confirmed to be normal on histopathology study. The typical intraoperative findings are adhesive exudate, white or cheese-like membranes covering the intraabdominal viscera, and fluid collections, but no visceral injuries can be identified. Therefore, it is crucial to include the VCP in the differential diagnosis of the acute abdomen after CS or vaginal delivery to avoid unnecessary laparotomy and removal of normal organs.

Vernix caseosa peritonitis after vaginal delivery

Introduction

Vernix caseosa peritonitis (VCP) is a very unusual complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity. Twenty-seven cases have been reported, and all occurred after cesarean section.

Case presentation

We present a case of VCP following vaginal delivery; this may be the first case reported after vaginal delivery. Mrs. A, 28 years old, gravida 3, para 2, with one previous cesarean section, was admitted at 41 weeks gestation in active labor. Vacuum extraction was performed to deliver a healthy male baby, 4.410 kg, Apgar scores 7, 8. She developed fever, acute abdominal pain, and distension about 3 hours after delivery. A diagnosis of acute abdomen was made. Laparotomy was performed and it revealed neither uterine scar rupture nor other surgical emergencies, but 500 mL of turbid fluid and some cheesy material on the serosal surface of all viscera. Biopsies were taken. She had a course of antibiotics and her recovery was complete. Histology of the peritoneal fluid and tissue biopsy resulted in a diagnosis of VCP.

Conclusion

Clinical diagnosis of peritonitis due to vernix caseosa should be considered in patients presenting postpartum with an acute abdomen after vaginal delivery.

Delayed presentation of vernix caseosa peritonitis

INTRODUCTION

Vernix caseosa peritonitis (VCP) is a rare and poorly recognised condition resulting from a sustained foreign body reaction to the vernix caseosa of the baby. This case-based review aims to highlight its importance for any medical team managing patients with peritonitis who have undergone a recent Caesarean section.

CASE REPORT

A 31-year-old woman presented 5 weeks after a Caesarean section with symptoms and signs of peritonitis.

CONCLUSIONS

Laparotomy and peritoneal lavage is the mainstay of treatment for VCP. Knowledge of the condition may stop inadvertent resection of normal intra-abdominal organs. Greater awareness of VCP is required to ensure earlier recognition as patients can recover well following timely operative intervention.

Vernix caseosa peritonitis - no longer rare or innocent: a case series

Introduction

Vernix Caseosa peritonitis is a rare post caesarean section complication with only 19 case reports in the literature to date. Vernix caseosa spilt at the time of caesarean section is thought to incite an inflammatory reaction, causing symptoms resembling an acute abdomen.

Case Presentation

We discuss three Caucasian patients (aged 32 to 43 years) who presented in our health sector in Sydney with vernix caseosa peritonitis. Each had a protracted course with significant comorbidities requiring surgical and medical intervention. This contrasts with other reports suggesting that a rapid resolution can be expected.

This cluster may be a consequence of the rising caesarean section rate, a heightened local awareness of the condition and possibly a result of leaving material in the paracolic gutters intraoperatively.

Conclusion

Our aim is to increase awareness among our obstetric and surgical colleagues of the characteristic clinical presentation and intra-operative findings of vernix caseosa peritonitis. We also point out that, in contrast to those presented here, not all patients require laparotomy.