Unexplained fever and abdominal pain after gynaecological surgery: the hidden culprit revealed
A 50-year-old post-menopausal woman underwent an abdominal hysterectomy due to complications associated with fibroids. A few days after the surgery, she began experiencing continuous abdominal pain near the incision site. Over time, the pain worsened and she developed a swinging type of fever. Despite the absence of any visible signs of infection at the incision site, the abdomen was tender to the touch. In light of these symptoms and signs, an intra-abdominal infection was suspected as a postoperative complication; and a course of broad-spectrum antibiotics was initiated. However, there was no significant improvement in the patient’s condition. To determine the cause of the unexplained symptoms during the postoperative period, imaging was conducted. The results revealed a suspicious mass in the right iliac fossa, but a definitive diagnosis could not be established through imaging alone.
Consequently, the patient was referred to the surgical ward for further evaluation and possible surgery. Upon examination of the abdomen, there were signs of infection within the abdominal cavity referred to as peritonitis (generalized tenderness, guarding and rigidity). On re-exploration of the abdomen, a retained gauze pack was discovered in the right iliac fossa. The pack was not only causing infection but also exacerbating the patient’s symptoms. It was promptly removed, and the abdominal cavity was thoroughly irrigated with normal saline before closure, with the use of a drain.
The patient experienced rapid improvement in her symptoms, the antibiotics were discontinued, and she made a complete recovery; being discharged from the hospital on the 14th day. This case highlights the critical importance of performing a comprehensive count of swabs, instruments and gauze packs, prior to closing the abdomen after surgery.
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