Conservative Surgical Management of Post-Cesarean Uterine Incisional Necrosis: A Case Report

Abstract

Objective: Myonecrosis is a complication of severe endometritis. The usual management of uterine incisional necrosis with dehiscence is hysterectomy. Conservative surgery, which involves wound debridement and resuture, presents a strong alternative to hysterectomy.
Case Report: In this study, a 27-year-old woman underwent an emergency cesarean section at 37 weeks due to fetal distress after labor induction for severe preeclampsia and intrauterine growth restriction. Five days after cesarean section, the patient developed purulent discharge from the incision, followed by tachycardia, leukocytosis, and fever. Imaging revealed endometritis with peritonitis symptoms. Her condition deteriorated in spite of broad-spectrum antibiotics, requiring an urgent exploratory laparotomy. Necrotic tissue was excised during surgery, and the uterine incision was effectively healed without necessitating a hysterectomy. She exhibited a satisfactory recovery, and a three-month follow-up revealed an unblemished uterus.
Conclusion: Uterine incision necrosis can be lethal if not appropriately recognized and treated. Conservative therapy can be a good alternative for properly chosen patients, even though hysterectomy is frequently required. Successful outcomes depend on early diagnosis, cautious patient selection, careful infection management, and surgical debridement. The long-term safety and reproductive implications of conservative treatment require further investigation.