Parietal Peritoneum Closure to Treat Bowel Evisceration Following Uneventful Cesarean Delivery

Abstract

Abstract

Background: Bowel evisceration after cesarean delivery is a rare but serious complication needing repeat laparotomy. The current technique of nonclosure of the peritoneum might be a predisposing factor. In addition, importance should be given to suturing techniques and avoidance of excessive dissection of muscle from rectus fascia. Case: A multigravida female with a previous cesarean scar underwent repeat section at 38 weeks of gestation. She had no intraoperative or postoperative complaints. A few hours after stitch removal on the seventh postoperative day, the patient had a sense of “something giving way,” and presented to the emergency room with total small bowel prolapse arising out of the cesarean wound. Immediate bowel reduction was performed with the patient under general anesthesia, with closure of the parietal peritoneum and application of tension sutures. Results: Her stitches were removed on postoperative day 10, and she had complete healing of the wound. Conclusions: Although peritoneal closure is associated with less postoperative pain and fever, and decreased operative time, there are no statistically significant data on wound dehiscence, adhesion formation, or long-term effects on subsequent pregnancy. Closure of the parietal peritoneum is good surgical practice, and might prevent prolapse through a small gap in the rectus fascia in the event of raised intraabdominal pressure. During cesarean delivery, making a midline knot while simultaneously approximating the rectus fascia ensures that there will be better tissue-holding capacity and effective fascial healing. (J GYNECOL SURG 30:234)