Puerperal retroperitoneal abscess caused by Clostridium difficile: case report and review of the literature.
BACKGROUND
Retroperitoneal infection can be lethal. Optimal management is still elusive to describe because of the small number of case reports. We presented here a case of retroperitoneal abscess caused by Clostridium difficile arising in the puerperal period.


METHODS
Case report and review of recent English-language literature.


RESULTS
The patient presented with surgical incision dehiscence. A gas-forming fluid collection was discovered in the pelvic retroperitoneal fascia by computed tomography, but the patient did not show marked symptoms of sepsis. Emergency laparotomy drainage and debridement were performed. Clostridium difficile was isolated, and she was treated with a three-week course of vancomycin. The patient recovered without major morbidity. Recent case reports describe variation in the course of the disease and management options for puerperal retroperitoneal infection.


CONCLUSIONS
Puerperal retroperitoneal abscess caused by C. difficile can present with minimal symptoms. Prompt recognition, early surgical intervention, and optimal use of antibiotics can reduce morbidity and prevent death.
1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital , Bangkok, Thailand .
Tuangsit
T
Wataganara
Anuwat
A
Sutantawibul
Sanitra
S
Anuwutnavin
Amornrut
A
Leelaporn
Young
Y
Rongrungruang
D000038:Abscess / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D001431:Bacteriological Techniques; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003646:Debridement; D004322:Drainage; D005260:Female; D006801:Humans; D007813:Laparotomy; D008853:Microscopy; D011645:Puerperal Infection / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011860:Radiography, Abdominal; D012187:Retroperitoneal Space / Q000473:pathology*; D014057:Tomography, X-Ray Computed