Noryani Mohd Samat
Hospital Sultan Ismail Petra, MalaysiaTitle: Post vaginal delivery with impending silent abdominal catastrophe: A case of vernix caseosa peritonitis
Abstract
Vernix caseosa peritonitis (VCP) is a very rare condition initially thought to be a complication of caesarean section caused by amniotic spillage and or meconium into maternal peritoneal cavity during operation, inciting an inflammatory reaction that mimics acute abdomen. However, few cases have been reported in post vaginal delivery and even antenatal leakage. Since 1976, around 34 cases have been reported all over the world. This is the first case known to be reported in Malaysia. Many have raised the importance of VCP clinical signs awareness among surgeons in order to avoid unnecessary procedures and morbidities. The diagnosis in this case was only made by histopathological examination following invasive midline laparotomy. Various conservative treatment options have been discussed over the years such as steroids and postoperative antibiotics therapy but none has been established. The use of intravenous immunoglobulin (IVIG) in this case has suppressed the inflammatory response and calmed the haemodynamic instability lowering the anaesthesia mortality risk. VCP should be kept in mind as one of the provisional diagnoses in antenatal or postnatal women who presented with unusual abdominal symptoms regardless of the delivery mode. Late or missed diagnosis might lead to unnecessary invasive procedures with elevated risk of mortality and morbidity in maternal patients.
Biography
Noryani Mohd Samat is currently serving in Hospital Sultan Ismail Petra, Kuala Krai, Malaysia. Being an intensivist for the past 9 years, she has encountered various cases of sepsis and found that sepsis-related maternal cases are quite challenging similar to her other interest, hiking.
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