Differential Diagnosis for Postpartum Fluid Leakage from Cesarean Incision
- Single most likely diagnosis:
- Seroma: This is the most likely diagnosis given the presence of a 4-cm defect at the right corner of the Pfannenstiel incision draining scant serosanguineous fluid without surrounding erythema, induration, or signs of infection. The clear fluid on the bandage initially and the subsequent drainage of serosanguineous fluid are consistent with a seroma, which is a collection of fluid that can occur at the site of surgical incisions.
- Other Likely diagnoses:
- Wound dehiscence: Although the rectus fascia is intact, the presence of a defect in the incision and fluid drainage could also suggest a partial wound dehiscence, especially if the fascial layer is compromised but not completely separated.
- Hematoma: The serosanguineous nature of the fluid could indicate a hematoma, which is a collection of blood outside of blood vessels, although the absence of significant swelling or tenderness makes this less likely.
- Do Not Miss diagnoses:
- Necrotizing fasciitis: This is a severe infection of the fascia and subcutaneous tissue that can be life-threatening. Although there are no areas of necrosis or crepitus and no surrounding erythema or induration, the recent history of intraamniotic infection increases the risk, and any signs of infection or tissue compromise should be taken very seriously.
- Enterocutaneous fistula: Although less likely given the absence of bowel symptoms or signs of peritonitis, an enterocutaneous fistula (an abnormal connection between the intestine and the skin) could present with fluid drainage from the incision site, especially if there was unintended bowel injury during the cesarean delivery.
- Rare diagnoses:
- Lymphocyst or lymphatic fistula: These conditions involve the leakage of lymphatic fluid and could present with clear or serous fluid drainage from the incision site, although they are less common and might be considered if other diagnoses are ruled out and the fluid characteristics are consistent with lymphatic origin.
- Abscess: A localized collection of pus could form in the incision site, but the absence of signs of infection such as erythema, induration, tenderness, or fever makes this less likely at this time.