Differential Diagnosis for Postpartum Sepsis and Bowel Perforation
- The patient's presentation of severe abdominal pain, signs and symptoms of sepsis, and bowel perforation within 24 hours of delivery are critical to the differential diagnosis.
Single Most Likely Diagnosis
- Postpartum endometritis with possible bowel perforation: This diagnosis is likely due to the patient's history of multiple C-sections, which increases the risk of endometritis and bowel injury. The patient's symptoms of severe abdominal pain, fever, and signs of sepsis are consistent with this diagnosis.
Other Likely Diagnoses
- Wound infection or dehiscence: The patient's history of multiple C-sections and obesity (BMI 45) increases the risk of wound complications, including infection and dehiscence.
- Pulmonary embolism: Although less likely, pulmonary embolism is a possible diagnosis given the patient's symptoms of tachypnea and severe pain.
- Uterine perforation: This diagnosis is possible given the patient's history of multiple C-sections and the presence of severe abdominal pain.
Do Not Miss Diagnoses
- Necrotizing fasciitis: This diagnosis is critical to consider due to the patient's symptoms of severe abdominal pain, fever, and signs of sepsis. Necrotizing fasciitis is a life-threatening condition that requires prompt diagnosis and treatment.
- Toxic shock syndrome: This diagnosis should be considered given the patient's symptoms of fever, tachypnea, and signs of sepsis.
- Bowel ischemia or infarction: This diagnosis is possible given the patient's symptoms of severe abdominal pain and signs of sepsis.
Rare Diagnoses
- Amniotic fluid embolism: Although rare, this diagnosis should be considered given the patient's symptoms of severe abdominal pain, fever, and signs of sepsis.
- Intra-abdominal shunt or fistula: This diagnosis is possible given the patient's history of multiple C-sections and the presence of severe abdominal pain.