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

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.