Peritonitis puerperal por vérnix caseosa. (Spanish)

Puerperal peritonitis associated with vernix. (English)

CLINICAL CASE: We report the case of a rare complication known as vernix caseosa peritonitis in a nuliparus woman who underwent a cesarean section on the 40+1 week. Four days later, she was readmitted with an acute abdomen and fever. An exploratory laparoscopy compatible with peritonitis was performed and no purulent or fecaloid collections were found. Microbiological cultures were negative and pathologic examination show anucleated squamous cells, therefore confirming the diagnosis of vernix caseosa peritonitis. The treatment is based on lavage and peritoneal aspiration and benefit of broad-spectrum antibiotic therapy is unclear. We review the literature, finding a total of 27 cases reported so far. Vernix caseosa peritonitis can be confused with other causes of acute abdomen, coming to perform unnecessary surgery and excision of healthy organs. It is essential that obstetricians and pathologists aware of this rare entity, to establish a diagnosis of suspicion and a more appropriate and conservative treatment. [ABSTRACT FROM AUTHOR]

CASO CLÍO: paciente de 40+1 semanas de embarazo, que acudió al servicio médico por peritonitis después de una cesárea urgente. Manifestó un cuadro de abdomen agudo y fiebre al cuarto día después de la cesárea. En la laparoscopia exploradora se encontró un cuadro compatible con peritonitis, sin colecciones purulentas o fecaloides. La negatividad de los cultivos intraperitoneales y el hallazgo de células escamosas anucleadas en la citología peritoneal confirmaron el diagnóstico de peritonitis química por vérnix caseosa. El tratamiento consistió en lavado y aspirado peritoneal y antibióticos de amplio espectro. Hasta el momento en la bibliografía se han reportado 27 casos de peritonitis por vérnix caseosa. Esta alteración puede confundirse con otras causas de abdomen agudo, e incluso dar lugar a cirugías innecesarias y exéresis de órganos sanos cuando no se diagnostica correctamente. Es fundamental que los obstetras y patólogos conozcan esta rara alteración, para establecer un diagnóstico de sospecha e implementar el tratamiento adecuado y conservador. [ABSTRACT FROM AUTHOR]

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