When fever lingers: A case series on pelvic abscesses after cesarean section

Abstract

Background: Pelvic abscess following cesarean section (CS) is an uncommon but serious postoperative complication that can significantly impact maternal health. Early recognition and tailored management are essential to reduce morbidity. Objective: To describe three cases of post-CS pelvic abscess treated with different modalities, highlighting diagnostic challenges and individualized therapeutic approaches. Methods: We retrospectively reviewed three women presenting with persistent fever and signs of infection after CS at Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu (2023-2025). Clinical presentations, imaging studies, treatment strategies, and outcomes were analyzed. Results: The first patient underwent diagnostic laparoscopy with adhesiolysis and drainage; the second required laparotomy due to loculated abscesses; the third was successfully managed with ultrasound-guided transvaginal drainage of hematometra. All patients showed clinical improvement following intervention. Conclusion: Persistent puerperal fever after cesarean section should prompt evaluation for pelvic abscess. A multidisciplinary approach involving appropriate imaging, culture-guided antibiotics, and individualized drainage techniques is key to favorable outcomes.