Life threatening fulminant peritonitis following spontaneous mid-trimester abortion

Abstract

An un-booked, thirty year second gravida from lower socioeconomic class, labourer by occupation ,residing in rural area was admitted with history of spontaneous abortion at 24 weeks of gestation at home. It was attended by untrained person .Patient developed distension of abdomen, breathlessness and high grade fever following day of abortion.. On examination, her general condition was poor. She had severe anaemia, tachycardia ,tachypnoea and high grade fever. She was ill-nourished with BMI of 16.Her abdomen was grossly distended up to xiphi-sternum giving rise to cardio-respiratory embarrassment. The abdomen was tense with cystic feel suggestive of either gross ascitis or a big ovarian cyst of 32 weeks size pregnant uterus. Patient underwent exploratory laparotomy with the provisional diagnosis of peritonitis or ruptured ovarian tumour. Laparotomy revealed four to five litres of thin watery, extremely foul smelling, purulent fluid in the abdominal cavity.There was no bowel injury. After through peritoneal lavage and after keeping peritoneal drain, abdomen was closed with tension sutures. Patient received fourth generation higher antibiotics, blood transfusions , intravenous albumin. Post operative period was relatively smooth. Patient went home after twelve days of admission.The case is presented because of its rarity in regards to primary aetiology ie spontaneous abortion, severity of sepsis, short duration of symptoms , clinical and radiological diagnostic dilemma and successful team efforts that saved the life.