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This is a CTA of the abdomen and pelvis.

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in a patient two days status post

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cesarean section presenting with acute

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onset abdominal pain and discomfort.

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On the left, we have arterial phase images and

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on the right, we have the venous phase images.

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As we scroll inferiorly, we begin to see the

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enlarged postpartum uterus come into view.

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This is normal myometrial vascularity

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that we see in the arterial phase.

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The endometrial cavity is distended with

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largely unenhancing blood products, in

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addition to some gas within the endometrial

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cavity, which is a normal finding in

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a patient in the postpartum period.

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As we scroll inferiorly, in addition to

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the gas within the endometrial cavity, we

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also see several locules of air extending

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anteriorly within the uterine myometrium

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and toward the level of the uterine serosa.

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There's air within the urinary bladder,

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which is likely due to instrumentation

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of the patient's Foley catheter.

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These are sagittal contrast-enhanced CT

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images of the pelvis for the same patient.

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Arterial phase images are on the left

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and venous phase images on the right.

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Again, we see a mildly enlarged postpartum

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uterus with distention of the endometrial

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cavity with blood products and gas.

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We see a defect in the lower uterine

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segment where there's tissue edema and

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focal disruption of the myometrium, which is

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consistent with the cesarean section site.

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However, we also see translocation of

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several of these locules of gas that are

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within the endometrial cavity through

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the cesarean section scar defect and

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toward the level of the uterine serosa.

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These are coronal contrast-enhanced CT

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images of the pelvis for the same patient.

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Again, the arterial phase images are on the left

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and the venous phase images are on the right.

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Again, we see distention of the endometrial

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cavity with gas and blood products.

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However, we see several areas where

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there is linear translocation of gas

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from the endometrial cavity through the

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myometrium and toward the uterine serosa.

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Because of these findings, a diagnosis of

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postoperative uterine dehiscence was suggested.

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The patient was hemodynamically stable

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and was managed successfully with uterine

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massage in the early postpartum period.

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Uterine dehiscence is defined as

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separation of the endometrium from the

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myometrium with intact uterine serosa.

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Remember that in the previous case that

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we showed, there was extension of gas

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from the endometrial cavity through the

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myometrium, but not through the uterine serosa.

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Uterine dehiscence is distinct from

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uterine rupture, which includes

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extension through the uterine serosa.

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CT is the imaging modality of choice

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for the evaluation of suspected uterine

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dehiscence in the postpartum period.

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Uterine dehiscence is a dangerous

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clinical entity and can contribute to

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significant postpartum hemorrhage, so

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prompt diagnosis and management are key.