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Fat necrosis of abdominal pannus following caesarean section in a woman with morbid obesity
  1. C Chiswick1,
  2. ES Cooper1,
  3. JE Norman2,
  4. FC Denison2
  1. 1Simpson Centre for Reproductive Health, Royal Infirmary Edinburgh, Edinburgh, UK
  2. 2University of Edinburgh, Centre for Reproductive Biology, Queens Medical Research Institute, Edinburgh, UK

Abstract

The authors present the first case report of a patient with morbid obesity who developed fat necrosis of the abdominal pannus following caesarean section. The patient was a 40-year-old primigravida with a body mass index of 44 kg/m2. After a relatively uncomplicated antenatal course, she underwent an emergency caesarean section for delay in first stage of labour at 2 cm dilation after induction of labour at 37 weeks gestation for non-proteinuric hypertension. Her immediate post natal period was uncomplicated and she was discharged on day 7 following removal of staples and deep tension sutures. She represented 3 weeks later with a 4 cm necrotic ulcer, 10 cm superior and distinctly separate to the caesarean section wound which was well healed. An ultrasound scan demonstrated a cavity 6×6×20 cm within the pannus. The patient was systemically well and swabs were negative. She was managed conservatively with twice weekly review by a multidisciplinary team including surgeons and obstetricians. However, by 6 weeks postnatal the necrotic area had enlarged to 10×8 cm, had started to leak copious amounts of offensive fatty exudate and there was new onset of cellulitis. The pannus was therefore debrided twice leaving a 20×5×8 cm defect. At operation, there was extensive fat necrosis of the abdominal pannus. Vacuum assisted closure therapy was used for 4 weeks. The wound was completely healed by 5 months postpartum. Dependant oedema and retraction of the pannus at operation may increase the risk of fat necrosis in morbidly obese women undergoing caesarean section.

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