Surgical Management of Severe Secondary Peritonitis Following Caesarean Section: A Case Report

Secondary peritonitis following Caesarean section is rare but potentially fatal. Prompt diagnosis, broad-spectrum antimicrobial therapy, and timely surgical source control are essential to reduce mortality. A 27-year-old woman presented on postoperative day 15 with severe abdominal pain, altered mental status, and diffuse peritonitis. Laboratory evaluation revealed marked leucocytosis (WBC 29.8 ×109/L) and neutrophilia. CT imaging showed pelvic abscesses and adhesive small bowel obstruction. Emergency laparotomy revealed a necrotic Caesarean uterine stump, appendiceal base necrosis, and a large pelvic abscess. Surgical management included subtotal hysterectomy, adhesiolysis, repair of the appendiceal base, abscess drainage, and peritoneal lavage. The patient recovered well with ICU care and broad-spectrum antibiotics. This case highlights the importance of early recognition and aggressive surgical intervention in post-Caesarean secondary peritonitis.