Differential Diagnosis for Postoperative Complications in a Postpartum Patient
- Single most likely diagnosis:
- Endometritis: This is the most likely diagnosis given the patient's symptoms of lower abdominal pain, chills, and fever (38.3 C) on postoperative day 2 after a cesarean delivery. The presence of a tender uterine fundus and mildly malodorous discharge further supports this diagnosis.
- Other Likely diagnoses:
- Wound infection: The scant serosanguineous drainage from the lower aspect of the incision could indicate the beginning of a wound infection, which is a common postoperative complication, especially after cesarean deliveries.
- Urinary tract infection (UTI): Although not directly indicated by the symptoms provided, UTIs are common in the postpartum period, especially after catheterization during surgery. The symptoms of lower abdominal pain and fever could potentially be attributed to a UTI.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Septic pelvic thrombophlebitis: This is a rare but potentially life-threatening condition that can occur postpartum, characterized by fever, pelvic pain, and signs of sepsis. It's crucial to consider this diagnosis due to its severity and the need for prompt anticoagulation therapy.
- Necrotizing fasciitis: Although rare, this condition is a medical emergency that requires immediate surgical intervention. The presence of pain with sitting and the serosanguineous drainage from the incision site, along with systemic signs of infection, make it essential to rule out this diagnosis.
- Rare diagnoses:
- Ovarian vein thrombosis: This condition can present with pelvic pain and fever in the postpartum period. It's a rare but serious condition that requires anticoagulation to prevent pulmonary embolism.
- Uterine dehiscence or rupture: Although more commonly associated with vaginal birth after cesarean (VBAC), uterine dehiscence can occur after a primary cesarean delivery, especially if there were complications during the surgery. This would be an emergency requiring immediate surgical intervention.