Uterine Incision Dehiscence Complicated by Intestinal Obstruction Following Cesarean Section: A Case Series

Uterine Incision Dehiscence Complicated by Intestinal Obstruction Following Cesarean Section: A Case Series | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Uterine Incision Dehiscence Complicated by Intestinal Obstruction Following Cesarean Section: A Case Series LianJing Liang, ShiTong Su, yu cao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8957352/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Uterine incision dehiscence (UID) can mimic intestinal obstruction features following cesarean delivery (CD), posing a diagnostic challenge due to overlapping symptoms with common postoperative ileus. This study aims to highlight the clinical and radiological distinctions between these conditions. Methods This case series study was conducted at two Chinese Hospital between April 2020 and June 2022. Three patients with UID mimicking intestinal obstruction (study group) and three with postoperative ileus (comparison group) were included. Data on clinical symptoms, laboratory results, CT findings, and surgical outcomes were analyzed. Results In the study group, the mean interval from cesarean delivery to symptom onset was approximately 9 days, whereas in the comparison group it was about 1.3 days. Lower abdominal pain was the predominant initial symptom in UID cases. Platelet counts in the study group averaged 496.7 × 10⁹/L, and CRP levels averaged 287 mg/L, both appearing higher than the corresponding values in the comparison group (182.7 × 10⁹/L and 144.9 mg/L, respectively). CT imaging in UID cases demonstrated characteristic findings, including discontinuity of the uterine muscle layer, pelvic free air, and diffuse peritonitis. All patients with UID underwent laparotomy, during which surgical site infections and abscesses were identified, while patients in the comparison group with postoperative ileus were managed successfully with conservative treatment. Conclusion UID mimicking intestinal obstruction presents distinct features, including delayed onset, severe inflammation markers, and specific CT signs. Clinicians should maintain high suspicion for UID in patients with prolonged or atypical postoperative symptoms. Uterine Dehiscence Cesarean Section Intestinal Obstruction Ileus Differential Diagnosis Figures Figure 1 Figure 2 Introduction Uterine incision dehiscence (UID) is a rare but potentially life-threatening complication following cesarean delivery (CD)( 1 – 3 ). It is characterized by partial or complete separation of the uterine incision line, which may result in severe postpartum sequelae such as massive hemorrhage( 4 ), pelvic hematoma, pelvic abscess, endomyometritis, diffuse peritonitis, and sepsis( 5 ). Although the precise global incidence is not well established due to underreporting and variation in diagnostic criteria, available literature suggests an incidence of approximately 0.1% after CD( 6 ), with higher rates in the presence of risk factors such as infection, suboptimal surgical technique, and comorbidities like diabetes. Given the more than 20 million cesarean deliveries performed worldwide each year, even this low incidence represents a meaningful clinical burden, particularly in low-resource settings where diagnostic capacity is limited. UID following CD may present with intestinal obstruction and abdominal pain, often posing a diagnostic challenge for emergency physicians and gynecologist. Differentiating UID-related obstruction from common postoperative ileus following CD is essential. Early recognition of UID that mimics the clinical features of ileus can help prevent misdiagnosis and ensure timely management. A diagnostic challenge arises when UID presents with features mimicking postoperative ileus or mechanical intestinal obstruction. Postoperative ileus is relatively common after abdominal surgery, including CD, and is characterized by transient bowel motility impairment leading to abdominal distension, pain, nausea, vomiting, and failure to pass flatus or stool. The main causes of UID following CD include infections( 7 – 9 ), surgical technique, improper incision location, suture technology and diabetes( 2 ). Among them, surgical site infections (SSI) is the most important cause( 10 , 11 ). However, UID with typical intestinal obstruction features represented a serious diagnostic pitfall, which is challenging to differentiate from common postoperative ileus following CD due to overlapping clinical symptoms and radiologic findings. While conservative management is generally effective for common postoperative ileus. Laparotomy is often required for ileus secondary to UID( 2 ). This study examines the clinical features, laboratory examination, computed tomography (CT) of the two distinct entities as well as their differential diagnosis and clinical management. By presenting these cases, we aim to raise awareness that UID after CD can mimic common postoperative ileus, posing a potentially life-threatening risk to patients. Methods Study design and patients This retrospective study investigated the UID patients following CD that exhibited symptoms of common postoperative ileus in West China Hospital of Sichuan University and the First People’s Hospital of Ziyang between April 2020 and June 2022. All methods were performed in accordance with the Declaration of Helsinki and relevant guidelines and regulations, and were approved by the Ethics Committee on Biomedical, West China Hospital of Sichuan University (Number: 2021 − 233). The informed consents from patients were waived for retrospective nature. The study group comprised adult patients who developed symptomatic intestinal obstruction secondary to UID after CD. Inclusion criteria of Study group were: ( 1 ) Adult patients underwent cesarean section and presented with symptomatic intestinal obstruction following deliver operation. ( 2 ) Patients showed one or more symptoms of postoperative ileus including abdominal pain, abdominal distention, nausea, vomiting and fever > 38℃ ( 12 ). ( 3 ) Typical CT images of intestinal obstruction, such as air-fluid levels and bowel dilatation, which were interpreted by experienced radiologist. ( 4 ) UID was diagnosed by experienced gynaecologist in laparotomy. Three patients were completely eligible for inclusion standard. The comparison group consisted of contemporaneous patients who developed common postoperative ileus following CD, diagnosed by experienced gynecologists, and who achieved satisfactory recovery with conservative treatment alone. Data collection Raw background data collected from our Hospital Information System (HIS) included obstetric history, clinical symptoms, CT figures, laboratory outcomes, treatments, intraoperative findings and prognosis. The main clinical characteristic were clinical symptoms, laboratory examination, radiology and laparotomy. These clinical managements were performed when patients were admitted to emergency room. The patient was followed up regularly after discharge and the prognosis data were collected. Results Clinical features Three patients were completely eligible for inclusion standard the study group and three for the comparison group. In all study group cases, the diagnosis of UID was confirmed by CT and subsequently verified during laparotomy ( Fig. 1 ) . As summarized in Table 1 , abdominal pain was reported in 5 of 6 patients (83.3%), while fever occurred in 4 patients (66.7%). Abdominal distension was present in all patients. Notably, vaginal bleeding was absent in both groups. All patients received intravenous antibiotics. Laparotomy was performed exclusively in the study group (100%), whereas all comparison group patients responded to conservative management. In the study group, lower abdominal pain was the initial symptom in all cases, preceding other gastrointestinal manifestations—a feature not observed in the comparison group, where pain onset was simultaneous with other symptoms. Table 1 Outcomes of clinical features among patients. Case 1 2 3 4 5 6 Age 18 22 24 24 31 40 History G2P2 G2P2 G2P2 G3P1 G4P1 G4P2 Last delivery time 04/08/2021 12/06/2022 03/04/2020 03/05/2020 27/05/2020 09/11/2021 Manner CD CD CD CD CD CD ER admission time 12/08/2021 16/06/2022 18/04/2020 04/05/2020 29/05/2020 10/11/2021 HR (bpm) 114 139 114 90 78 100 BP (mmHg) 115/63 138/92 115/63 114/70 118/80 127/84 Clinical diagnosis IO and UID following CD IO and UID following CD IO and UID following CD Postoperative ileus Postoperative ileus Postoperative ileus Abdominal pain Yes Yes Yes Yes No Yes Pain onset First symptom First symptom First symptom Simultaneous – Simultaneous Pain location Lower abdomen Lower abdomen Lower abdomen Upper abdomen – Lower abdomen Abdominal distention Yes Yes Yes Yes Yes Yes Nausea Yes No Yes Yes No Yes Body temperature (℃) 39.2 36.5 39.6 36.4 39.4 38.5 Vaginal bleeding No No No No No No Treatments IVA (Ceftizoxime Sodium) + SCP + L + UIR + PCP IVA (Sulbactam Sodium/Cefoperazone Sodium) + SCP + L + UIR + PCP IVA (Ceftizoxime Sodium) + SCP + L + UIR + PCP IVA (Tazobactam Sodium/Piperacillin Sodium) + SCP IVA (Cefoxitin Sodium) + SCP IVA (Cefuroxime Sodium) + SCP Outcome Alive Alive Alive Alive Alive Alive G, gravida; P, para; CD, cesarean delivery; ER, emergency room; IO, intestinal obstruction; UID, uterine incision dehiscence; LAP, lower abdominal pain; UAP, upper abdominal pain; IVA, intravenous antibiotics; SCP, stomach catheter placement; L, laparotomy; UIR, uterine incision repair; PCP, pelvic catheter placement; HR, heart rate (bpm); BP, blood pressure (mmHg). *Case 1–3 were assigned to the study group and Case 4–6 were assigned to the comparison group. Laboratory findings As shown in Table 2 , all patients demonstrated leukocytosis. CRP levels were elevated in 5 patients (83.3%). The mean CRP level appeared higher in the study group (287.0 mg/L) than in the comparison group (144.9 mg/L), although no statistical comparison was performed. The mean platelet count appeared higher in the study group (496.7 × 10^9/L) compared with the comparison group (182.7 × 10^9/L). Blood cultures were negative in most cases, with one study group patient had a positive cervical culture for Enterococcus faecalis (Case 2). Table 2 Outcomes of laboratory examination among patients. Case 1 2 3 4 5 6 Ranges WBC ( × 10 9 /L ) 15.33 23.23 10.72 24.51 12.95 19.42 3.5–9.5 Platelets (×10⁹/L) 491 414 585 283 101 164 100–300 Hemoglobin (g/L) 159 100 76 98 110 96 115–150 CRP (mg/L) 418 315 128 N/A 228.4 61.5 0–5 LDH (IU/L) 230 148 203 N/A N/A N/A 120–250 Electrolytes (Na⁺/K⁺, mmol/L) 145.5/3.45 140.5/3.60 130.5/3.60 139.9/3.85 141.6/3.92 138.1/3.71 Na⁺ 135.0-150.0 K⁺ 3.50–5.50 Culture Blood-N Blood-N Cervix-P (E.F) Blood-N N/A N/A Blood-N P or N WBC, white blood cell; CRP, C-reactive protein; LDH, lactic dehydrogenase; N/A, not available; P, positive; N, negative; E.F, enterococcus faecalis. *Case 1–3 were assigned to the study group and Case 4–6 were assigned to the comparison group. Radiologic findings The CT revealed the radiology comparisons between two groups ( Fig. 2 ) . CT findings are detailed in Table 3 . Both groups exhibited bowel dilatation, air–fluid levels, and an enlarged uterus with uneven density. However, features significantly associated with UID were present only in the study group, including discontinuity of the uterine muscle layer, pelvic–uterine free air, parietal peritoneum thickening, and diffuse peritonitis. These findings were absent in all comparison cases. Table 3 Outcomes of computed tomography (CT) among patients. Case 1 2 3 4 5 6 Air-fluid levels in bowel Y Y Y Y Y Y Bowel dilatation Y Y Y Y Y Y Enlarged uterus with uneven density Y Y Y Y Y Y Discontinuity of the uterine muscle layer Y Y Y N N N Pelvic-uterine free air and parietal peritoneum thickening Y Y Y N N N Diffuse peritonitis Y Y Y N N N Y, yes; N, no. Intraoperative findings Laparotomy results for the study group are summarized in Table 4 . All three patients had uterine surgical site infections with abscess formation along the incision line, as well as extensive bowel adhesions due to severe intra-abdominal infection. No bowel necrosis was observed. Multidisciplinary team (MDT) discussed the pathogenesis of UID mimic postoperative ileus (Figure S1 ) . All cases underwent uterine incision repair with re-approximation of healthy tissue margins, along with pelvic catheter placement. The mean duration of postoperative intravenous antibiotic therapy was 10–12 days, and the mean hospital stay was 14 days in the study group and 3.3 days in the comparison group. Table 4 Details of laparotomy in study group. Uterine incision dehiscence Case 1 Case 2 Case 3 Y Y Y LSCS Y Y Y SSI following CD Y Y Y Abscess on the uterine incision line Y Y Y Omentum majus adhesion N N Y Intra abdominal diffuse infections Y Y Y Abdominal and pelvic abscess Y Y Y Bowel adhesion and dilatation Y Y Y Bowel necrosis N N N UIR and catheter placement Y Y Y IVA following UIR (days) 10 12 9 General ward (days) 13 19 10 LSCS, lower segment caesarean section; SSI, surgical site infections; CD, cesarean delivery; UIR, uterine incision repair; IVA, intravenous antibiotics; Y, yes; N, no. *IVA was stopped using when the count of white blood cell returned to normal range. Key observations between groups are summarized in Table 5 . The study group had a mean interval from CD to onset of ileus symptoms of 9.0 days compared with 1.3 days in the comparison group. Platelet counts appeared higher in the study group, with CRP levels showing a similar elevation. All patients were discharged in stable condition. Table 5 Comparison of clinical and laboratory variables between groups. Age (years) Study group (n = 3) Comparison group (n = 3) Range, 18–24 Mean, 21.3 Range, 24–40 Mean, 31.7 Time interval from receiving CD to IO occurring (days) Range, 4–15 Mean, 9 Range, 1–2 Mean, 1.3 Symptom appearing order Abdominal pain first appearing before other symptoms Abdominal pain simultaneous appearing with other symptoms Platelets (× 10 9 /L) Range, 414–585 Mean, 496.7 Range, 101–283 Mean, 182.7 CRP (mg/L) Range, 128–418 Mean, 287 Range, 61.5-228.4 Mean, 144.9 Discontinuity of the uterine muscle layer in CT Yes No Pelvic-uterine free air in CT Yes No Parietal peritoneum thickening in CT Yes No Diffuse peritonitis in CT Yes No Hospital admission (days) Range, 10–19 Mean, 14 Range, 2–5 Mean, 3.3 CD, cesarean delivery; IO, intestinal obstruction; UID, uterine incision dehiscence; CRP, C-reactive protein; CT, computed tomography. Discussion This study highlights that UID patients following CD can present with clinical and radiologic features closely resembling common postoperative ileus. Compared with ileus, UID-related obstruction showed a longer postoperative interval before symptom onset, initial lower abdominal pain, and significantly higher platelet counts and CRP levels. CT revealed distinguishing features—discontinuity of the uterine muscle layer, pelvic uterine free air, parietal peritoneum thickening, and diffuse peritonitis that were absent in comparisons. These differences are clinically important because UID generally requires prompt surgical repair, whereas postoperative ileus is usually managed conservatively. Common postoperative ileus following CD is typically a transient motility disorder resulting from surgical manipulation or postoperative factors( 12 , 16 ). Reported etiologies include adhesion( 17 ), volvulus( 18 , 19 ), intussusceptions, opioid drugs( 20 ), hernia, tumors, unstable hemodynamic status. Abdominal operation may lead to bowel adhesions. Abdominal pressure changes following CD may lead to volvulus, intussusceptions. Excessive opioid drugs may lead to adynamic ileus( 21 ). Our results show that although UID-related obstruction and common postoperative ileus share symptoms and CT findings, they are pathophysiologically distinct with different prognoses and treatments. UID requires prompt surgical repair to prevent severe infection, while postoperative ileus usually resolves conservatively. Recognizing UID-specific features—delayed onset, localized lower abdominal pain, elevated inflammatory markers, and characteristic CT changes—is essential to avoid misdiagnosis and delays in care. UID can lead to postpartum massive bleeding( 4 ), pelvic hematoma, pelvic abscess, endomyometritis, diffuse peritonitis and sepsis( 5 ). In our series, all UID cases were complicated by significant intra-abdominal inflammation, which contributed to bowel dilatation and adhesions, thereby producing clinical features mimicking intestinal obstruction. These findings support prior evidence that intestinal obstruction can represent a secondary manifestation of severe pelvic or abdominal inflammation( 14 , 15 ). So, it is challenging to differentiate UID with typical intestinal obstruction features from common postoperative ileus following CD. In our study, UID-related obstruction and common postoperative ileus shared several features, including abdominal pain, fever, abdominal distension, leukocytosis, and CT findings of bowel dilatation, air–fluid levels, and an enlarged uterus with uneven density. The absence of vaginal bleeding in both groups was misleading, as bleeding is often considered a key indicator of UID( 3 , 22 ). hese overlaps can obscure the diagnosis, underscoring the need to identify subtle differences between the two conditions to ensure appropriate management. Common postoperative ileus usually presents abdominal distension that can lead to abdominal pain, nausea and vomiting( 16 ). For such patients, abdominal distension first occurs. Subsequently, abdominal pain, nausea and vomiting occurs. However, lower abdominal pain first occurred in our study group that was special. It revealed pain position overlap with uterine surgical site( 11 ). So, incision dehiscence should be suspected. In our study, the mean interval from CD to onset of ileus was appeared to be longer in the UID group than in comparisons (9.0 vs. 1.3 days), consistent with prior reports that common postoperative ileus typically occurs within 1–4 days postoperatively( 14 , 18 , 19 , 21 , 23 ). There was enough time for microbiology infections that may provide trigger and time for UID. A study reported a 25 years old woman with UID 7 days after CD, who presented with incision infection and was managed with laparotomy( 1 ). A study reported three patients with UID 7–14 days, who all showed abdominal pain and purulent vaginal discharge and were managed with intravenous antibiotics( 2 ). This time-course difference is an important diagnostic clue distinguishing UID-related obstruction from common postoperative ileus Laboratory results also differed: the study group were higher platelet counts, consistent with previous reports linking thrombocytosis to postoperative incision complications( 24 ), and reflecting platelets’ role in wound healing (25, 26) . Study group platelets elevated, which may represent a feedback regulation to UID. C-reactive protein (CRP) as a vital predictor of intra abdominal and surgical site infections following operation had been widely accepted( 27 , 28 ). Higher CRP revealed higher risk of SSI and abdominal infections( 29 , 30 ). In our study group, mean CRP 287 mg/L revealed serious SSI and abdominal infections. Thirdly, there were different computed tomography findings between two groups. Discontinuity of the uterine muscle layer may showed poor wound healing or uterine rupture( 15 ). Pelvic-uterine free air was a symbol of uterine perforation. Parietal peritoneum thickening was the critical reaction of abdominal inflammation. Of note, Study group showed diffuse peritonitis symbol, which was rare for common postoperative ileus following CD. Because common postoperative ileus usually is adynamic or pseudo-obstruction, which may exhibits a mild peritonitis symbol. Any imaging modalities such as ultrasonography( 2 , 13 ), magnetic resonance imaging( 31 ) and computed tomography can be used for the diagnosis of UID. Exploratory laparotomy is the most important way to diagnose and treat UID with deceptive intestinal obstruction. Uterine incision repair with reapproximation of healthy margins can be considered for such patients. However, in case of obvious wound infection, endomyometritis and/or intraabdominal abscess, a hysterectomy must be considered. In our study group, all cases received uterine incision repair and catheter placement( 32 ). Because their mean age was 21.3 (range, 18–24) years. Saving uterus is very significant for young patient. All patients received intravenous antibiotics( 33 , 34 ) after repair operations and discharged from hospital successfully. UID mimic typical intestinal obstruction and common postoperative ileus following CD are two distinct entities with completely different treatments and prognosis. Correct diagnosis is crucial so that the appropriate clinical managements can be performed to such patients. Our study was limited by the small sample size, which constrained the possibility of conducting meaningful statistical analyses and increased the risk of chance findings. In addition, the retrospective design may have introduced potential biases, and the data were derived from a single region, which could limit the generalizability of the findings. Despite these limitations, this small-scale study was necessary, as UID mimics postoperative ileus—a rare but potentially life-threatening condition—and provides valuable insights for establishing a correct diagnosis and guiding appropriate clinical management. Limitations This study has several limitations that should be considered when interpreting the findings. The small sample size, inherent to the rarity of this condition, precludes meaningful statistical analysis and increases the risk of chance observations, while the retrospective design and single-region data source may introduce selection bias and limit generalizability to broader populations. Additionally, the absence of standardized diagnostic protocols across the two participating centers could have influenced case identification and management decisions. Despite these constraints, this case series provides valuable preliminary insights into a rare but serious complication, and the detailed clinical, laboratory, and radiological characterization offered here may serve as a useful foundation for future multicenter prospective studies with larger cohorts to validate these distinguishing features. Conclusion This case series demonstrates that uterine incision dehiscence (UID) following cesarean delivery can present with clinical and radiological features mimicking mechanical intestinal obstruction, posing a diagnostic challenge due to overlapping symptoms with common postoperative ileus. Our observations suggest that UID-related obstruction may be distinguished by later symptom onset (approximately 9 days versus 1–2 days post-cesarean), initial lower abdominal pain preceding other gastrointestinal symptoms, markedly elevated inflammatory markers (platelets and CRP), and characteristic CT findings including uterine muscle layer discontinuity, pelvic free air, and diffuse peritonitis. However, given the small sample size and retrospective design of this study, these findings should be considered preliminary and hypothesis-generating rather than definitive. Clinicians should maintain a high index of suspicion for UID in patients presenting with delayed or atypical postoperative obstructive symptoms, as timely surgical intervention is critical. Larger prospective studies are needed to validate these distinguishing features. Declarations Ethical Approval and Consent to participate The institutional review board of West China Hospital, Sichuan University approved the study and informed consents were waived for retrospective nature. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This study was supported by funding of Science & Technology Department of Sichuan Province (Numbers: 2021YFS0186; 2021YFS0189). Author Contribution L.J.L. and S.T.S. conceptualized and designed the study, coordinated, supervised data collection, interpreted the results and wrote the paper. Y.C. as the corresponding author was responsible for our emergency center, and critically reviewed the manuscript for important intellectual content and cared for patients and kept medical record. L.J.L. as operating physician of the Day Surgery Center participated in emergency surgical procedure. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. Acknowledgements Not applicable Data Availability No, all of the material is owned by the authors and/or no permissions are required References Bharatam KK, Sivaraja P, Abineshwar N, Thiagarajan V, Thiagarajan D, Bodduluri S, et al. The tip of the iceberg: Post caesarean wound dehiscence presenting as abdominal wound sepsis. Int J Surg case Rep. 2015;9:69–71. El-Agwany AS. Conservative management of infected postpartum uterine dehiscence after cesarean section. J Med ultrasound. 2018;26(1):59–61. Wagner M-S, Bédard M-J. Postpartum uterine wound dehiscence: a case report. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8957352","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":620885128,"identity":"49c576d5-cbd3-4f00-a901-cdf8e80b5125","order_by":0,"name":"LianJing Liang","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"LianJing","middleName":"","lastName":"Liang","suffix":""},{"id":620885129,"identity":"1d22b7ec-63e9-440a-b9cd-296c590897e2","order_by":1,"name":"ShiTong Su","email":"","orcid":"","institution":"West China Second University Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"ShiTong","middleName":"","lastName":"Su","suffix":""},{"id":620885130,"identity":"27619d7a-3e5a-4765-a9b4-98470deec434","order_by":2,"name":"yu cao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArklEQVRIiWNgGAWjYNCCCgYGAxK1nCFZC2MbKVr42w8fk+add1jenP/wMwmGmjuEtUicSUuT5t122HDnjDQzCYZjzwhrMWDIMQNquZ1gcIOHTYKx4TARWvjfALXMAWo5f4ZYLRIgWxqAWg7kEKlF4sazZMs5x/4bbriRZmyRcIwILfz9yQdvvKlJkzc4f/jhjQ81RGgBAhYJODOBKA0MDMwfiFQ4CkbBKBgFIxUAAFTbNxSLfREEAAAAAElFTkSuQmCC","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"yu","middleName":"","lastName":"cao","suffix":""}],"badges":[],"createdAt":"2026-02-24 12:23:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8957352/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8957352/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106961855,"identity":"15aa214a-65af-4133-9e55-a700bcf5e965","added_by":"auto","created_at":"2026-04-15 09:27:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":133052,"visible":true,"origin":"","legend":"\u003cp\u003e3 patients with UID mimic intestinal obstruction were verified by CT and laparotomy. Their symptoms occurrence and clinical managements were showed in time order. Abdominal pain was the first onset before other symptoms.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8957352/v1/8a17bd92dfcbac53ed1c01fd.png"},{"id":106947136,"identity":"0a260207-8c92-4ebe-ae3d-ba19c9b25aad","added_by":"auto","created_at":"2026-04-15 06:48:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1013751,"visible":true,"origin":"","legend":"\u003cp\u003eCT showed the radiology comparisons between study and comparison groups. Study group included case 1-3 (a-c). Comparison group included case 4-6 (d-f). Bowel dilatation, air-fluid levels and enlarged uterus with uneven density were common features for all cases (a-f). Discontinuity of the uterine muscle layer, pelvic-uterine free air, parietal peritoneum thickening and serious peritonitis were specific symbols for UID mimic IO following CD (a-c). UID, uterine incision dehiscence; IO, intestinal obstruction; CD, cesarean delivery.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8957352/v1/bcab8f2b93dfc07128c8e67d.png"},{"id":106963370,"identity":"ff30b22d-4c7a-49dc-8398-c8cbba58a912","added_by":"auto","created_at":"2026-04-15 09:43:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2396197,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8957352/v1/cccfcccf-f151-4e21-a705-f2b42b002018.pdf"},{"id":106961426,"identity":"60235471-197f-4879-a815-2d2334079fe7","added_by":"auto","created_at":"2026-04-15 09:25:30","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":1480812,"visible":true,"origin":"","legend":"","description":"","filename":"suplementalmaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-8957352/v1/97ea3da329aecbea21b3e9dd.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Uterine Incision Dehiscence Complicated by Intestinal Obstruction Following Cesarean Section: A Case Series","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUterine incision dehiscence (UID) is a rare but potentially life-threatening complication following cesarean delivery (CD)(\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). It is characterized by partial or complete separation of the uterine incision line, which may result in severe postpartum sequelae such as massive hemorrhage(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), pelvic hematoma, pelvic abscess, endomyometritis, diffuse peritonitis, and sepsis(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Although the precise global incidence is not well established due to underreporting and variation in diagnostic criteria, available literature suggests an incidence of approximately 0.1% after CD(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), with higher rates in the presence of risk factors such as infection, suboptimal surgical technique, and comorbidities like diabetes. Given the more than 20\u0026nbsp;million cesarean deliveries performed worldwide each year, even this low incidence represents a meaningful clinical burden, particularly in low-resource settings where diagnostic capacity is limited.\u003c/p\u003e \u003cp\u003eUID following CD may present with intestinal obstruction and abdominal pain, often posing a diagnostic challenge for emergency physicians and gynecologist. Differentiating UID-related obstruction from common postoperative ileus following CD is essential. Early recognition of UID that mimics the clinical features of ileus can help prevent misdiagnosis and ensure timely management. A diagnostic challenge arises when UID presents with features mimicking postoperative ileus or mechanical intestinal obstruction. Postoperative ileus is relatively common after abdominal surgery, including CD, and is characterized by transient bowel motility impairment leading to abdominal distension, pain, nausea, vomiting, and failure to pass flatus or stool. The main causes of UID following CD include infections(\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), surgical technique, improper incision location, suture technology and diabetes(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Among them, surgical site infections (SSI) is the most important cause(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, UID with typical intestinal obstruction features represented a serious diagnostic pitfall, which is challenging to differentiate from common postoperative ileus following CD due to overlapping clinical symptoms and radiologic findings. While conservative management is generally effective for common postoperative ileus. Laparotomy is often required for ileus secondary to UID(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This study examines the clinical features, laboratory examination, computed tomography (CT) of the two distinct entities as well as their differential diagnosis and clinical management. By presenting these cases, we aim to raise awareness that UID after CD can mimic common postoperative ileus, posing a potentially life-threatening risk to patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and patients\u003c/h2\u003e \u003cp\u003eThis retrospective study investigated the UID patients following CD that exhibited symptoms of common postoperative ileus in West China Hospital of Sichuan University and the First People\u0026rsquo;s Hospital of Ziyang between April 2020 and June 2022. All methods were performed in accordance with the Declaration of Helsinki and relevant guidelines and regulations, and were approved by the Ethics Committee on Biomedical, West China Hospital of Sichuan University (Number: 2021\u0026thinsp;\u0026minus;\u0026thinsp;233). The informed consents from patients were waived for retrospective nature.\u003c/p\u003e \u003cp\u003eThe study group comprised adult patients who developed symptomatic intestinal obstruction secondary to UID after CD. Inclusion criteria of Study group were: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Adult patients underwent cesarean section and presented with symptomatic intestinal obstruction following deliver operation. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Patients showed one or more symptoms of postoperative ileus including abdominal pain, abdominal distention, nausea, vomiting and fever\u0026thinsp;\u0026gt;\u0026thinsp;38℃ (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Typical CT images of intestinal obstruction, such as air-fluid levels and bowel dilatation, which were interpreted by experienced radiologist. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) UID was diagnosed by experienced gynaecologist in laparotomy. Three patients were completely eligible for inclusion standard. The comparison group consisted of contemporaneous patients who developed common postoperative ileus following CD, diagnosed by experienced gynecologists, and who achieved satisfactory recovery with conservative treatment alone.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eRaw background data collected from our Hospital Information System (HIS) included obstetric history, clinical symptoms, CT figures, laboratory outcomes, treatments, intraoperative findings and prognosis. The main clinical characteristic were clinical symptoms, laboratory examination, radiology and laparotomy. These clinical managements were performed when patients were admitted to emergency room. The patient was followed up regularly after discharge and the prognosis data were collected.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eClinical features\u003c/h2\u003e \u003cp\u003eThree patients were completely eligible for inclusion standard the study group and three for the comparison group. In all study group cases, the diagnosis of UID was confirmed by CT and subsequently verified during laparotomy \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. As summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, abdominal pain was reported in 5 of 6 patients (83.3%), while fever occurred in 4 patients (66.7%). Abdominal distension was present in all patients. Notably, vaginal bleeding was absent in both groups. All patients received intravenous antibiotics. Laparotomy was performed exclusively in the study group (100%), whereas all comparison group patients responded to conservative management. In the study group, lower abdominal pain was the initial symptom in all cases, preceding other gastrointestinal manifestations\u0026mdash;a feature not observed in the comparison group, where pain onset was simultaneous with other symptoms.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOutcomes of clinical features among patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistory\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eG2P2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG2P2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG2P2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eG3P1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eG4P1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eG4P2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLast delivery time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e04/08/2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12/06/2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e03/04/2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e03/05/2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27/05/2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e09/11/2021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eManner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eER admission time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12/08/2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16/06/2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18/04/2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e04/05/2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29/05/2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10/11/2021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHR (bpm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBP (mmHg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e115/63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138/92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115/63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e114/70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e118/80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e127/84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIO and UID following CD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIO and UID following CD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIO and UID following CD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePostoperative ileus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePostoperative ileus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePostoperative ileus\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbdominal pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePain onset\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst symptom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFirst symptom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFirst symptom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSimultaneous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSimultaneous\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePain location\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower abdomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLower abdomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLower abdomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUpper abdomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLower abdomen\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbdominal distention\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNausea\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBody temperature (℃)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVaginal bleeding\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatments\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIVA (Ceftizoxime Sodium)\u0026thinsp;+\u0026thinsp;SCP\u0026thinsp;+\u0026thinsp;L\u0026thinsp;+\u0026thinsp;UIR\u0026thinsp;+\u0026thinsp;PCP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIVA (Sulbactam Sodium/Cefoperazone Sodium)\u0026thinsp;+\u0026thinsp;SCP\u0026thinsp;+\u0026thinsp;L\u0026thinsp;+\u0026thinsp;UIR\u0026thinsp;+\u0026thinsp;PCP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIVA (Ceftizoxime Sodium)\u0026thinsp;+\u0026thinsp;SCP\u0026thinsp;+\u0026thinsp;L\u0026thinsp;+\u0026thinsp;UIR\u0026thinsp;+\u0026thinsp;PCP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIVA (Tazobactam Sodium/Piperacillin Sodium)\u0026thinsp;+\u0026thinsp;SCP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIVA (Cefoxitin Sodium)\u0026thinsp;+\u0026thinsp;SCP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIVA (Cefuroxime Sodium)\u0026thinsp;+\u0026thinsp;SCP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutcome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eG, gravida; P, para; CD, cesarean delivery; ER, emergency room; IO, intestinal obstruction; UID, uterine incision dehiscence; LAP, lower abdominal pain; UAP, upper abdominal pain; IVA, intravenous antibiotics; SCP, stomach catheter placement; L, laparotomy; UIR, uterine incision repair; PCP, pelvic catheter placement; HR, heart rate (bpm); BP, blood pressure (mmHg). *Case 1\u0026ndash;3 were assigned to the study group and Case 4\u0026ndash;6 were assigned to the comparison group.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLaboratory findings\u003c/h3\u003e\n\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, all patients demonstrated leukocytosis. CRP levels were elevated in 5 patients (83.3%). The mean CRP level appeared higher in the study group (287.0 mg/L) than in the comparison group (144.9 mg/L), although no statistical comparison was performed. The mean platelet count appeared higher in the study group (496.7 \u0026times; 10^9/L) compared with the comparison group (182.7 \u0026times; 10^9/L). Blood cultures were negative in most cases, with one study group patient had a positive cervical culture for Enterococcus faecalis (Case 2).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOutcomes of laboratory examination among patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eRanges\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWBC (\u003c/b\u003e\u0026times; 10\u003csup\u003e9\u003c/sup\u003e/L\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e23.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e19.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e3.5\u0026ndash;9.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlatelets (\u0026times;10⁹/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e100\u0026ndash;300\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemoglobin (g/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e115\u0026ndash;150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCRP (mg/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e228.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e61.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLDH (IU/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e120\u0026ndash;250\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eElectrolytes (Na⁺/K⁺, mmol/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145.5/3.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e140.5/3.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e130.5/3.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e139.9/3.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e141.6/3.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e138.1/3.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNa⁺ 135.0-150.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eK⁺ 3.50\u0026ndash;5.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCulture\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlood-N\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBlood-N\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCervix-P (E.F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBlood-N\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBlood-N\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eP or N\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eWBC, white blood cell; CRP, C-reactive protein; LDH, lactic dehydrogenase; N/A, not available; P, positive; N, negative; E.F, enterococcus faecalis. *Case 1\u0026ndash;3 were assigned to the study group and Case 4\u0026ndash;6 were assigned to the comparison group.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRadiologic findings\u003c/h2\u003e \u003cp\u003eThe CT revealed the radiology comparisons between two groups \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. CT findings are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Both groups exhibited bowel dilatation, air\u0026ndash;fluid levels, and an enlarged uterus with uneven density. However, features significantly associated with UID were present only in the study group, including discontinuity of the uterine muscle layer, pelvic\u0026ndash;uterine free air, parietal peritoneum thickening, and diffuse peritonitis. These findings were absent in all comparison cases.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOutcomes of computed tomography (CT) among patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAir-fluid levels in bowel\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBowel dilatation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnlarged uterus with uneven density\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiscontinuity of the uterine muscle layer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePelvic-uterine free air and parietal peritoneum thickening\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiffuse peritonitis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eY, yes; N, no.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eIntraoperative findings\u003c/h3\u003e\n\u003cp\u003eLaparotomy results for the study group are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. All three patients had uterine surgical site infections with abscess formation along the incision line, as well as extensive bowel adhesions due to severe intra-abdominal infection. No bowel necrosis was observed. Multidisciplinary team (MDT) discussed the pathogenesis of UID mimic postoperative ileus \u003cb\u003e(Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e)\u003c/b\u003e. All cases underwent uterine incision repair with re-approximation of healthy tissue margins, along with pelvic catheter placement. The mean duration of postoperative intravenous antibiotic therapy was 10\u0026ndash;12 days, and the mean hospital stay was 14 days in the study group and 3.3 days in the comparison group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDetails of laparotomy in study group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eUterine incision dehiscence\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCase 3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLSCS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSSI following CD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbscess on the uterine incision line\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOmentum majus adhesion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntra abdominal diffuse infections\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbdominal and pelvic abscess\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBowel adhesion and dilatation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBowel necrosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUIR and catheter placement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIVA following UIR (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeneral ward (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eLSCS, lower segment caesarean section; SSI, surgical site infections; CD, cesarean delivery; UIR, uterine incision repair; IVA, intravenous antibiotics; Y, yes; N, no. *IVA was stopped using when the count of white blood cell returned to normal range.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eKey observations between groups are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The study group had a mean interval from CD to onset of ileus symptoms of 9.0 days compared with 1.3 days in the comparison group. Platelet counts appeared higher in the study group, with CRP levels showing a similar elevation. All patients were discharged in stable condition.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of clinical and laboratory variables between groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy group (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eComparison group (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange, 18\u0026ndash;24\u003c/p\u003e \u003cp\u003eMean, 21.3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange, 24\u0026ndash;40\u003c/p\u003e \u003cp\u003eMean, 31.7\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime interval from receiving CD to IO occurring (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange, 4\u0026ndash;15\u003c/p\u003e \u003cp\u003eMean, 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange, 1\u0026ndash;2\u003c/p\u003e \u003cp\u003eMean, 1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSymptom appearing order\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbdominal pain first appearing before other symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbdominal pain simultaneous appearing with other symptoms\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlatelets (\u0026times; 10\u003c/b\u003e\u003csup\u003e\u003cb\u003e9\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange, 414\u0026ndash;585\u003c/p\u003e \u003cp\u003eMean, 496.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange, 101\u0026ndash;283\u003c/p\u003e \u003cp\u003eMean, 182.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCRP (mg/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange, 128\u0026ndash;418\u003c/p\u003e \u003cp\u003eMean, 287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange, 61.5-228.4\u003c/p\u003e \u003cp\u003eMean, 144.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiscontinuity of the uterine muscle layer in CT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePelvic-uterine free air in CT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParietal peritoneum thickening in CT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiffuse peritonitis in CT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital admission (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange, 10\u0026ndash;19\u003c/p\u003e \u003cp\u003eMean, 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange, 2\u0026ndash;5\u003c/p\u003e \u003cp\u003eMean, 3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eCD, cesarean delivery; IO, intestinal obstruction; UID, uterine incision dehiscence; CRP, C-reactive protein; CT, computed tomography.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights that UID patients following CD can present with clinical and radiologic features closely resembling common postoperative ileus. Compared with ileus, UID-related obstruction showed a longer postoperative interval before symptom onset, initial lower abdominal pain, and significantly higher platelet counts and CRP levels. CT revealed distinguishing features—discontinuity of the uterine muscle layer, pelvic uterine free air, parietal peritoneum thickening, and diffuse peritonitis that were absent in comparisons. These differences are clinically important because UID generally requires prompt surgical repair, whereas postoperative ileus is usually managed conservatively.\u003c/p\u003e \u003cp\u003eCommon postoperative ileus following CD is typically a transient motility disorder resulting from surgical manipulation or postoperative factors(\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e). Reported etiologies include adhesion(\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e), volvulus(\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e), intussusceptions, opioid drugs(\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e), hernia, tumors, unstable hemodynamic status. Abdominal operation may lead to bowel adhesions. Abdominal pressure changes following CD may lead to volvulus, intussusceptions. Excessive opioid drugs may lead to adynamic ileus(\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e). Our results show that although UID-related obstruction and common postoperative ileus share symptoms and CT findings, they are pathophysiologically distinct with different prognoses and treatments. UID requires prompt surgical repair to prevent severe infection, while postoperative ileus usually resolves conservatively. Recognizing UID-specific features—delayed onset, localized lower abdominal pain, elevated inflammatory markers, and characteristic CT changes—is essential to avoid misdiagnosis and delays in care.\u003c/p\u003e \u003cp\u003eUID can lead to postpartum massive bleeding(\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e), pelvic hematoma, pelvic abscess, endomyometritis, diffuse peritonitis and sepsis(\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e). In our series, all UID cases were complicated by significant intra-abdominal inflammation, which contributed to bowel dilatation and adhesions, thereby producing clinical features mimicking intestinal obstruction. These findings support prior evidence that intestinal obstruction can represent a secondary manifestation of severe pelvic or abdominal inflammation(\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e). So, it is challenging to differentiate UID with typical intestinal obstruction features from common postoperative ileus following CD.\u003c/p\u003e \u003cp\u003eIn our study, UID-related obstruction and common postoperative ileus shared several features, including abdominal pain, fever, abdominal distension, leukocytosis, and CT findings of bowel dilatation, air–fluid levels, and an enlarged uterus with uneven density. The absence of vaginal bleeding in both groups was misleading, as bleeding is often considered a key indicator of UID(\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e). hese overlaps can obscure the diagnosis, underscoring the need to identify subtle differences between the two conditions to ensure appropriate management.\u003c/p\u003e \u003cp\u003eCommon postoperative ileus usually presents abdominal distension that can lead to abdominal pain, nausea and vomiting(\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e). For such patients, abdominal distension first occurs. Subsequently, abdominal pain, nausea and vomiting occurs. However, lower abdominal pain first occurred in our study group that was special. It revealed pain position overlap with uterine surgical site(\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e). So, incision dehiscence should be suspected. In our study, the mean interval from CD to onset of ileus was appeared to be longer in the UID group than in comparisons (9.0 vs. 1.3 days), consistent with prior reports that common postoperative ileus typically occurs within 1–4 days postoperatively(\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e). There was enough time for microbiology infections that may provide trigger and time for UID. A study reported a 25 years old woman with UID 7 days after CD, who presented with incision infection and was managed with laparotomy(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e). A study reported three patients with UID 7–14 days, who all showed abdominal pain and purulent vaginal discharge and were managed with intravenous antibiotics(\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e). This time-course difference is an important diagnostic clue distinguishing UID-related obstruction from common postoperative ileus\u003c/p\u003e \u003cp\u003eLaboratory results also differed: the study group were higher platelet counts, consistent with previous reports linking thrombocytosis to postoperative incision complications(\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e), and reflecting platelets’ role in wound healing\u003csup\u003e\u003cb\u003e(25, 26)\u003c/b\u003e\u003c/sup\u003e. Study group platelets elevated, which may represent a feedback regulation to UID. C-reactive protein (CRP) as a vital predictor of intra abdominal and surgical site infections following operation had been widely accepted(\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e). Higher CRP revealed higher risk of SSI and abdominal infections(\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e). In our study group, mean CRP 287 mg/L revealed serious SSI and abdominal infections.\u003c/p\u003e \u003cp\u003eThirdly, there were different computed tomography findings between two groups. Discontinuity of the uterine muscle layer may showed poor wound healing or uterine rupture(\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e). Pelvic-uterine free air was a symbol of uterine perforation. Parietal peritoneum thickening was the critical reaction of abdominal inflammation. Of note, Study group showed diffuse peritonitis symbol, which was rare for common postoperative ileus following CD. Because common postoperative ileus usually is adynamic or pseudo-obstruction, which may exhibits a mild peritonitis symbol. Any imaging modalities such as ultrasonography(\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e), magnetic resonance imaging(\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e) and computed tomography can be used for the diagnosis of UID.\u003c/p\u003e \u003cp\u003eExploratory laparotomy is the most important way to diagnose and treat UID with deceptive intestinal obstruction. Uterine incision repair with reapproximation of healthy margins can be considered for such patients. However, in case of obvious wound infection, endomyometritis and/or intraabdominal abscess, a hysterectomy must be considered. In our study group, all cases received uterine incision repair and catheter placement(\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e). Because their mean age was 21.3 (range, 18–24) years. Saving uterus is very significant for young patient. All patients received intravenous antibiotics(\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e) after repair operations and discharged from hospital successfully. UID mimic typical intestinal obstruction and common postoperative ileus following CD are two distinct entities with completely different treatments and prognosis. Correct diagnosis is crucial so that the appropriate clinical managements can be performed to such patients.\u003c/p\u003e \u003cp\u003eOur study was limited by the small sample size, which constrained the possibility of conducting meaningful statistical analyses and increased the risk of chance findings. In addition, the retrospective design may have introduced potential biases, and the data were derived from a single region, which could limit the generalizability of the findings. Despite these limitations, this small-scale study was necessary, as UID mimics postoperative ileus—a rare but potentially life-threatening condition—and provides valuable insights for establishing a correct diagnosis and guiding appropriate clinical management.\u003c/p\u003e "},{"header":"Limitations","content":"\u003cp\u003eThis study has several limitations that should be considered when interpreting the findings. The small sample size, inherent to the rarity of this condition, precludes meaningful statistical analysis and increases the risk of chance observations, while the retrospective design and single-region data source may introduce selection bias and limit generalizability to broader populations. Additionally, the absence of standardized diagnostic protocols across the two participating centers could have influenced case identification and management decisions. Despite these constraints, this case series provides valuable preliminary insights into a rare but serious complication, and the detailed clinical, laboratory, and radiological characterization offered here may serve as a useful foundation for future multicenter prospective studies with larger cohorts to validate these distinguishing features.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case series demonstrates that uterine incision dehiscence (UID) following cesarean delivery can present with clinical and radiological features mimicking mechanical intestinal obstruction, posing a diagnostic challenge due to overlapping symptoms with common postoperative ileus. Our observations suggest that UID-related obstruction may be distinguished by later symptom onset (approximately 9 days versus 1\u0026ndash;2 days post-cesarean), initial lower abdominal pain preceding other gastrointestinal symptoms, markedly elevated inflammatory markers (platelets and CRP), and characteristic CT findings including uterine muscle layer discontinuity, pelvic free air, and diffuse peritonitis. However, given the small sample size and retrospective design of this study, these findings should be considered preliminary and hypothesis-generating rather than definitive. Clinicians should maintain a high index of suspicion for UID in patients presenting with delayed or atypical postoperative obstructive symptoms, as timely surgical intervention is critical. Larger prospective studies are needed to validate these distinguishing features.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthical Approval and Consent to participate\u003c/strong\u003e \u003cp\u003eThe institutional review board of West China Hospital, Sichuan University approved the study and informed consents were waived for retrospective nature.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was supported by funding of Science \u0026amp; Technology Department of Sichuan Province (Numbers: 2021YFS0186;\u003c/p\u003e \u003cp\u003e2021YFS0189).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eL.J.L. and S.T.S. conceptualized and designed the study, coordinated, supervised data collection, interpreted the results and wrote the paper. Y.C. as the corresponding author was responsible for our emergency center, and critically reviewed the manuscript for important intellectual content and cared for patients and kept medical record. L.J.L. as operating physician of the Day Surgery Center participated in emergency surgical procedure. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eNo, all of the material is owned by the authors and/or no permissions are required\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBharatam KK, Sivaraja P, Abineshwar N, Thiagarajan V, Thiagarajan D, Bodduluri S, et al. The tip of the iceberg: Post caesarean wound dehiscence presenting as abdominal wound sepsis. Int J Surg case Rep. 2015;9:69\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Agwany AS. Conservative management of infected postpartum uterine dehiscence after cesarean section. J Med ultrasound. 2018;26(1):59\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWagner M-S, B\u0026eacute;dard M-J. Postpartum uterine wound dehiscence: a case report. J Obstet Gynaecol Can. 2006;28(8):713\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Ma N-Y, Pang X-A. Uterine incision dehiscence 3 mo after cesarean section causing massive bleeding: A case report. World J Clin Cases. 2020;8(11):2392.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThyagaraju C, Makam S, Yedla D, Papa D. Conservative surgical management of immediate post-cesarean uterine dehiscence and pelvis abscess due to Proteus mirabilis infection: A rare complication of Puerperal endomyometritis. Int J Reprod Contracept Obstet Gynecol. 2021;10(7):2895\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFigueir\u0026oacute;-Filho EA, Gomez JM, Farine D. Risk Factors Associated with Uterine Rupture and Dehiscence: A Cross-Sectional Canadian Study. Rev Bras Ginecol Obstet. 2021;43(11):820\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeffah J. Re-laparotomy after cesarean section. Int J Gynecol Obstet. 2005;88(3):253\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGedikbasi A, Akyol A, Asar E, Bingol B, Uncu R, Sargin A, et al. Re-laparotomy after cesarean section: operative complications in surgical delivery. Arch Gynecol Obstet. 2008;278(5):419\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRivlin ME, Carroll CS, Morrison JC. Conservative surgery for uterine incisional necrosis complicating cesarean delivery. Obstet Gynecol. 2004;103(5 Part 2):1105\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErritty M, Hale J, Thomas J, Thompson A, Wright R, Low A, et al. Evaluation of independent risk factors associated with surgical site infections from caesarean section. Arch Gynecol Obstet. 2023;308(6):1775\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMathai M, Hofmeyr GJ, Mathai NE. Abdominal surgical incisions for caesarean section. Cochrane Database Syst Reviews. 2013(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharoenkwan K, Palapinyo C. Early solid food after cesarean section and postoperative ileus. Int J Gynecol Obstet. 2005;90(2):144\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDahal J, Saha R. Scar Rupture in Early Puerperium: A Case Report. JNMA: J Nepal Med Association. 2022;60(249):491.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSenagore AJ. Pathogenesis and clinical and economic consequences of postoperative ileus. Clin Exp Gastroenterol. 2010:87\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKanao S, Fukuda A, Fukuda H, Miyamoto M, Marumoto E, Furuya K, et al. Spontaneous uterine rupture at 15 weeks' gestation in a patient with a history of cesarean delivery after removal of shirodkar cerclage. Am J Perinatol Rep. 2014;4(01):001\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSenagore AJ. Pathogenesis and clinical and economic consequences of postoperative ileus. Am J Health-System Pharm. 2007;64(20Supplement13):S3\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Took S, Platt R, Tulandi T. Adhesion-related small-bowel obstruction after gynecologic operations. Am J Obstet Gynecol. 1999;180(2):313\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSascha Dua R, Rothnie N, Gray E. Sigmoid volvulus in the puerperium. Int J Gynecol Obstet. 2007;97(3):195.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKolusari A, Kurdoglu M, Adali E, Yildizhan R, Sahin HG, Kotan C. Sigmoid volvulus in pregnancy and puerperium: a case series. Cases J. 2009;2(1):9275.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSherrod BA, Kim R, Hunsaker J, Rada C, Christensen C, Stoddard GJ, et al. Postoperative ileus risk after posterior thoracolumbar fusion performed with total intravenous anesthesia versus inhaled anesthesia. J Neurosurgery: Spine. 2022;38(3):307\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHennebery RB, Burke CA, Bank TC, Hoffman MK. Risk factors for postoperative ileus after cesarean delivery. Am J Obstet Gynecol MFM. 2022;4(6):100713.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaria J, Henriques C, do Carmo Silva M, Mira R. Rupture of an unscarred uterus diagnosed in the puerperium: a rare occurrence. Case Rep. 2012;2012:bcr2012006372.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarma M, Harma MI, Karadeniz G, Arikan I, Barut A, Bayar U. Idiopathic ileoileal invagination two days after cesarean section. J Obstet Gynecol Res. 2011;37(2):160\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJin P, Pan Q, Lin Y, Dong Y, Zhu J, Liu T, et al. Platelets facilitate wound healing by mitochondrial transfer and reducing oxidative stress in endothelial cells. Oxidative Med Cell Longev. 2023;2023(1):2345279.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScopelliti F, Cattani C, Dimartino V, Mirisola C, Cavani A. Platelet derivatives and the immunomodulation of wound healing. Int J Mol Sci. 2022;23(15):8370.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang L, Dong Y, Li C, Han S, Cheng B. Effect of platelet concentrate prepared by different methods on the healing of full-thickness skin defects. J Cosmet Dermatol. 2022;21(11):5910\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePlat VD, Voeten DM, Daams F, van der Peet DL, Straatman J. C-reactive protein after major abdominal surgery in daily practice. Surgery. 2021;170(4):1131\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Winsen M, McSorley ST, McLeod R, MacDonald A, Forshaw MJ, Shaw M, et al. Postoperative C-reactive protein concentrations to predict infective complications following gastrectomy for cancer. J Surg Oncol. 2021;124(7):1060\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKurokawa Y, Yamashita K, Kawabata R, Fujita J, Imamura H, Takeno A, et al. Prognostic value of postoperative C-reactive protein elevation versus complication occurrence: a multicenter validation study. Gastric Cancer. 2020;23(5):937\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHajong R, Newme K, Nath CK, Moirangthem T, Dhal MR, Pala S. Role of serum C-reactive protein and interleukin-6 as a predictor of intra-abdominal and surgical site infections after elective abdominal surgery. J Family Med Prim Care. 2021;10(1):403\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonnez O, Jadoul P, Squifflet J, Donnez J. Laparoscopic repair of wide and deep uterine scar dehiscence after cesarean section. Fertil Steril. 2008;89(4):974\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHan S, Ryu K, Ahn K, Cho S, Lee C, Hong S. Conservative treatment of uterine fistula with abdominal abscess after caesarean section. J Obstet Gynaecol. 2015;35(6):650\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMori N, Takigawa A, Kagawa N, Kenri T, Yoshida S, Shibayama K, et al. Pelvic abscess due to Mycoplasma hominis following caesarean section. JMM Case Rep. 2016;3(4):e005059.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHameed A, El-Halwagy H, Mehta V, Donnellan I, Mcneillis N, Zaidi J. Subphrenic abscess resulting in multi-organ failure after caesarean section. J Obstet Gynaecol. 2010;30(3):312\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Uterine Dehiscence, Cesarean Section, Intestinal Obstruction, Ileus, Differential Diagnosis","lastPublishedDoi":"10.21203/rs.3.rs-8957352/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8957352/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUterine incision dehiscence (UID) can mimic intestinal obstruction features following cesarean delivery (CD), posing a diagnostic challenge due to overlapping symptoms with common postoperative ileus. This study aims to highlight the clinical and radiological distinctions between these conditions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case series study was conducted at two Chinese Hospital between April 2020 and June 2022. Three patients with UID mimicking intestinal obstruction (study group) and three with postoperative ileus (comparison group) were included. Data on clinical symptoms, laboratory results, CT findings, and surgical outcomes were analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the study group, the mean interval from cesarean delivery to symptom onset was approximately 9 days, whereas in the comparison group it was about 1.3 days. Lower abdominal pain was the predominant initial symptom in UID cases. Platelet counts in the study group averaged 496.7 × 10⁹/L, and CRP levels averaged 287 mg/L, both appearing higher than the corresponding values in the comparison group (182.7 × 10⁹/L and 144.9 mg/L, respectively). CT imaging in UID cases demonstrated characteristic findings, including discontinuity of the uterine muscle layer, pelvic free air, and diffuse peritonitis. All patients with UID underwent laparotomy, during which surgical site infections and abscesses were identified, while patients in the comparison group with postoperative ileus were managed successfully with conservative treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUID mimicking intestinal obstruction presents distinct features, including delayed onset, severe inflammation markers, and specific CT signs. Clinicians should maintain high suspicion for UID in patients with prolonged or atypical postoperative symptoms.\u003c/p\u003e","manuscriptTitle":"Uterine Incision Dehiscence Complicated by Intestinal Obstruction Following Cesarean Section: A Case Series","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-15 06:48:26","doi":"10.21203/rs.3.rs-8957352/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-25T15:31:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-17T14:36:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"129995665867176620393322002247135209504","date":"2026-04-17T14:19:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"299261950378131911380125776022199890511","date":"2026-04-17T12:08:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294964582293193081816351824418137298003","date":"2026-04-16T07:07:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-15T06:12:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15302595299099380898716830079498510552","date":"2026-04-15T05:36:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T16:57:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-06T11:32:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-16T12:17:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-16T08:37:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-03-16T07:07:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6bdbcbe8-bcb4-4c03-8369-c1d9383fa94f","owner":[],"postedDate":"April 15th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-15T06:48:26+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-15 06:48:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8957352","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8957352","identity":"rs-8957352","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}