Michel E Rivlin1, C Shannon Carroll, John C Morrison. 1. Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA. calford@ob-gyn.umsmed.edu
Abstract
BACKGROUND: Hysterectomy is the usual management of uterine incisional necrosis with dehiscence as a complication of cesarean delivery. Debridement with resuture of the uterine wound as an alternative therapy would conserve fertility at the risk of continued necrosis and infection. Unfortunately the literature provides few guidelines in deciding when to select conservative surgery and whether it is a safe option. CASES: Three cases are presented with uterine incisional necrosis complicating cesarean delivery. In 2 instances, uterine conservation was considered an acceptable option and was successfully completed. The third patient underwent hysterectomy because of clinical features deemed to be contraindications to conservative surgery. CONCLUSION: In well-selected patients, debridement and resuture of the uterine incision is an acceptable alternative to hysterectomy for uterine incisional necrosis.
BACKGROUND: Hysterectomy is the usual management of uterine incisional necrosis with dehiscence as a complication of cesarean delivery. Debridement with resuture of the uterine wound as an alternative therapy would conserve fertility at the risk of continued necrosis and infection. Unfortunately the literature provides few guidelines in deciding when to select conservative surgery and whether it is a safe option. CASES: Three cases are presented with uterine incisional necrosis complicating cesarean delivery. In 2 instances, uterine conservation was considered an acceptable option and was successfully completed. The third patient underwent hysterectomy because of clinical features deemed to be contraindications to conservative surgery. CONCLUSION: In well-selected patients, debridement and resuture of the uterine incision is an acceptable alternative to hysterectomy for uterine incisional necrosis.
Authors: Chris-Henrik Wulfert; Christian Theodor Müller; Ahmed Farouk Abdel-Kawi; Wolfgang Schulze; Henning Schmidt-Seithe; Sonko Borstelmann; Gunnar Loske Journal: Innov Surg Sci Date: 2020-10-01