E.C.

35/F

Chief Complaint: Wound Discharge

History of Present Illness:

Two months prior to admission patient underwent repeat low transverse cesarean section
secondary to uncontrolled blood pressure. She had two visits with her attending physician
post partum.

Then one month prior to admission patient noted yellowish foul smelling discharge coming
out of the surgical site. She was given antibiotics but provided no relief. Thus referred to
surgical department.

Menstrual History
Menarch at 13 with regular intervals lasting 5 days using 2-3 pads per day. (+)
Dysmenorrhea.

OB History
G2P2 (1102)
G1 - 2006 S/P Primary Low Segment Transverse Cesarean Section Secondary to
Uncontrolled High Blood Pressure. Live Birth 1.9 kilograms
G2- May 25, 2016 Repeat Low Segment Transverse Cesarean Section
Secondary 2.4 kilograms live birth.

Past Surgical History

None other than Cesarean Section
P.E.
Skin: Pallor
Abdomen: Yellow wound discharge at surgical site, with open wound, tenderness right
lower abdomen, indirect tenderness, rebound tenderness.

CBC:
Red Cells 4.7 x 10^12/L
Hemoglobin 12.5 g/dL
Hematocrit 38.4%
MCV 82 f
MCH 27 pg
Platelet 338 X 10^9
White Blood Cells 19.3
Differential Count
Neutrophils: 92
Lymphocytes : 3
Monocytes: 5

Chest X-Ray:
Negative

Ultrasound:
Suggestive of a break at the lower anterior uterine margin (area of operative site) with tract
formation 5 cm long communicating to the abdominal wall at the hypogastrium towards the
side of wound dehiscence with minimal free fuid around the adnexal areas with reactive
fatty tissue induration around the uterus.

Wound Culture:
Escherichia coli

Thus patient underwent explore lap.