Sezaryen sonrası gelişen endomyometrit/peritonit, veziko-vajinal fistül ve PCR negatif covid-19 akciğer tutulumu benzeri infiltrasyon: Olgu sunumu / Endomyometritis/peritonitis, vesico-vaginal fistula and pcr negative covid-19 lung ınvolvement-like ınfiltration after cesarean section-case report
Yükleniyor...
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Maltepe Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Hastamız 41 yaşındadır. Hasta sezaryen sonrası 12. Günde acile nefes darlığı ve karın ağrısı ile geldi. Hastanın troponin I değeri negatif, D-Dimer değeri 10700 µg/L, hemoglobin (Hgb) değeri 7.7 gr/dL ve C-Reaktif Protein (CRP) değeri 180 mg/L olarak geldi. Covid PCR negatif olarak geldi. Toraks bilgisayarlı tomografide (BT) sağ akciğer alt lob süperior kesimde buzlu cam (CO-RADS 3-4) ve konsolidasyon alanları izlendi. Kontrastlı toraks BT’de emboli saptanmadı. Abdomen BT’de karaciğer altı, dalak altı ve batında yaygın yoğun içerikli sıvı koleksiyonları saptandı. Hastaya olası dissemine intravasküler koagülasyon (DIC) için eritrosit süspansiyonu ve taze donmuş plazma verildi. Takipte D-Dimer değerleri 12200-12200-11900-13000-13300 µg/L olarak geldi. Pelvik muayenede vezikovajinal fistül tespit edildi. Fistül için konservatif tedavi planlandı. Üriner kateter takıldı. Medikal tedaviye yanıt alınan hastada oral tedaviye geçildikten sonra tekrar CRP değerlerinde artma ve klinik semptomlar başladı (CRP: 138 mg/L). Hastaya laparotomi yapılması planlandı. İntraoperatif karaciğer altı ve parakolik alanda enfeksiyona sekonder sıvı birikimleri görüldü. Hastaya total abdominal histerktomi+bilateral salpenjektomi yapıldı. İntraoperatif vezikovajinal fistülün kapandığı görüldü. Patoloji sonucu endomyometrit olarak geldi. D-Dimer değerleri normale döndü. Kontrollerde sorun yaşanmadı.
A 41-year-old patient came to the emergency room with shortness of breath and abdominal pain on the 12th day after cesarean section. Troponin I was negative, D-Dimer value was 10700 µg/L, Hemoglobin (Hgb) value was 7.7 gr/dL and C-Reactive Protein (CRP) value was 180 mg/L. Covid PCR was negative. On thorax tomography (CT), there were ground glass (CO-RADS 3-4) and consolidation areas in the superior part of the lower lobe of the right lung. There was no embolism in contrast-enhanced thorax CT. Abdominal CT revealed diffuse collections of dense fluid in the sub-hepatic, sub-splenic, and abdomen. Red cell suspension and fresh frozen plasma were given for possible disseminated intravascular coagulation (DIC). D-Dimer values were found as 12200-12200-11900-13000-13300 µg/L in the follow-up. A vesicovaginal fistula was detected in the pelvic examination. Conservative treatment was planned for the fistula. Urinary catheter was inserted. In the patient who responded to medical treatment, after switching to oral treatment, an increase in CRP values and clinical symptoms started again (CRP: 138 mg/L). The patient underwent laparotomy. Fluid accumulations secondary to infection were observed in the intraoperative sub-hepatic and paracolic areas. The patient underwent total abdominal hysterectomy+bilateral salpingectomy. The pathology result was endomyometritis. It was observed that the intraoperative vesico-vaginal fistula was closed. D-Dimer values returned to normal. There were no problems with the controls.
A 41-year-old patient came to the emergency room with shortness of breath and abdominal pain on the 12th day after cesarean section. Troponin I was negative, D-Dimer value was 10700 µg/L, Hemoglobin (Hgb) value was 7.7 gr/dL and C-Reactive Protein (CRP) value was 180 mg/L. Covid PCR was negative. On thorax tomography (CT), there were ground glass (CO-RADS 3-4) and consolidation areas in the superior part of the lower lobe of the right lung. There was no embolism in contrast-enhanced thorax CT. Abdominal CT revealed diffuse collections of dense fluid in the sub-hepatic, sub-splenic, and abdomen. Red cell suspension and fresh frozen plasma were given for possible disseminated intravascular coagulation (DIC). D-Dimer values were found as 12200-12200-11900-13000-13300 µg/L in the follow-up. A vesicovaginal fistula was detected in the pelvic examination. Conservative treatment was planned for the fistula. Urinary catheter was inserted. In the patient who responded to medical treatment, after switching to oral treatment, an increase in CRP values and clinical symptoms started again (CRP: 138 mg/L). The patient underwent laparotomy. Fluid accumulations secondary to infection were observed in the intraoperative sub-hepatic and paracolic areas. The patient underwent total abdominal hysterectomy+bilateral salpingectomy. The pathology result was endomyometritis. It was observed that the intraoperative vesico-vaginal fistula was closed. D-Dimer values returned to normal. There were no problems with the controls.
Açıklama
Anahtar Kelimeler
Endometrit, D-Dimer, Sezaryen, Peritonit, Vezikovajinal Fistül, Endometritis, D-Dimer, Cesarean section, Peritonitis, Vesicovaginal Fistula
Kaynak
Maltepe Tıp Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
14
Sayı
3
Künye
Kaplan, İ. (2022). Sezaryen sonrası gelişen endomyometrit/peritonit, veziko-vajinal fistül ve PCR negatif covid-19 akciğer tutulumu benzeri infiltrasyon: Olgu sunumu / Endomyometritis/peritonitis, vesico-vaginal fistula and pcr negative covid-19 lung ınvolvement-like ınfiltration after cesarean section-case report. Maltepe Tıp Dergisi, Maltepe Üniversitesi. 14(3), s. 69-73.
