morphine and Foreign-Body-Reaction

Maternal peritonitis secondary to fetal vernix caseosa is considered an infrequent complication of cesarean section in which commonly spilled amniotic fluid is incompletely lavaged. Nine of the 10 reported cases have been diagnosed in the postpartum period after an uneventful cesarean section. Characteristically, vernix elicits granulomatous inflammation, occasionally with a mass lesion simulating bowel perforation and leading to colectomy. One case of antenatal leakage of amniotic fluid has been reported, also with granulomatous inflammation. We report two additional cases of antenatal leakage, both with acute inflammation lacking granulomatous features or mass lesions. The interval between amniotic fluid contamination and histopathologic evaluation is the basis for variations in the inflammatory pattern.

Topics: Adult; Amniotic Fluid; Cesarean Section; Fallopian Tubes; Female; Foreign-Body Reaction; Humans; Infant, Newborn; Male; Meconium; Peritonitis; Pregnancy; Vernix Caseosa

We present two cases of histologically proven maternal intraperitoneal granulomata following cesarean section delivery. One patient presented during the immediate postpartum period with clinical symptoms consistent with subphrenic abscess. The other patient required operative intervention for a suspected ruptured tubo-ovarian abscess. In both cases, microscopic examination of the tissue obtained at the time of reoperation showed granuloma reaction, lanugo hair, and fetal squamous cells consistent with meconium deposition. The authors conclude that meconium granuloma should enter the differential diagnosis in cesarean section patients with unexplained postoperative pain.

Topics: Adult; Cesarean Section; Female; Foreign-Body Reaction; Granuloma; Humans; Meconium; Pain, Postoperative; Peritoneal Diseases; Pregnancy