Successful Management of Complications Due to a Cesarean Section in a Patient With a Complex Obstetric History: A Case Report and Review of Preventive Strategies

A multiparous 37-year-old female patient (G7P3A4) with a complex obstetric history consisting of a myomectomy for uterine fibroids and a previous cesarean section (C-section) resulted in complicated intra- and postpartum events. The incidental cystotomy during the C-section was managed conservatively by catheterization. Postoperatively the patient suffered from postpartum menorrhagia and an enlarged uterus and was managed with an explorative laparotomy concluding with extensive lysis of adhesions and total abdominal hysterectomy and bilateral salpingectomy. The patient did well postoperatively and was discharged after 48 hours. She returned for an outpatient follow-up one week later and was reassured that her pain would improve within six to eight weeks. This case study details the complications and aftermath of intense intra-abdominal adhesions and calls for a better understanding of the management of adhesions for abdominal procedures.