Case notes
A 32-year-old G2P1 with a history of cesarean delivery had an uncomplicated vaginal delivery at term. Two days after giving birth, she developed high-grade fever, tachycardia, hypotension, lower abdominal pain, and right flank pain. Computed tomography (CT) scan at that time revealed bladder wall thickening and a small amount of pelvic free fluid. She was started on broad-spectrum antibiotics for suspected pyelonephritis and sepsis. However, urine cultures were negative and patient had persistent severe flank pain although her fever and hemodynamic status improved. A repeat CT scan performed 3 days later revealed a uterine defect in the region of the previous cesarean scar with a pelvic collection tracking into the right pararenal space ( Figures 1 and 2 ). Pelvic ultrasound also demonstrated the uterine rupture ( Figure 3 ). CT-guided drainage of this collection ( Figure 4 ) resulted in complete recovery, and the fluid drained did not grow any organisms as patient was on antibiotics. Patient had no desire for future pregnancies and was counseled on the risks of pregnancy in the setting of an unrepaired uterine defect.
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