POST-OPERATIVE CAPNOCYTOPHAGA SPUTIGENA PRESENTING AS DIFFUSE RECALCITRANT INTRA-ABDOMINAL ABSCESSES

Objectives:

Objective: Cesarean section has a number of potential complications, to include iatrogenic surgical injury, thromboembolic events, and infection of endometrium, pelvis, or urinary tract. The incidence of post-cesarean pelvic abscess with antibiotic prophylaxis is less than 10%, and most often caused by Staphylococcus species. Capnocytophaga Sputigena is rarely implicated as the cause of intra-abdominal abscess because it is almost exclusively found in oral flora, and therefore more commonly associated with bite wounds. Despite its rarity in intra-abdominal infection, there are examples of this atypical presentation, and an awareness of this organism as a potential etiology of surgical infection is relevant for both obstetric and general surgeons.

Methods: We report a case of a young female 3 weeks status post uncomplicated cesarean section who presented with multiple intra-abdominal abscesses recalcitrant to percutaneous drainage, and who eventually required surgical exploration and drainage.

Results: A 19-year-old female presented just over a week after an uncomplicated C-section with complaint of abdominal discomfort and fevers. Imaging revealed multiple intra-abdominal fluid collections concerning for infection, and she underwent percutaneous drainage. Cultures revealed the presence of Capnocytophaga Sputigena. Percutaneous drainage was unable to provide significant source control, with the collections persisting despite multiple well-sited drains and aggressive intravenous antibiotic therapy. Due to resource unavailability, she was transferred to our institution, where she underwent surgical exploration with a multi-specialty team of obstetric and acute care surgeons.
Intraoperatively, we identified numerous pockets of thick purulent matter as well as extensive fibrinous rind, most prominently posterior to uterus as well as in the right upper quadrant. The collections were successfully drained, while taking care to avoid inadvertent iatrogenic injury to the inflamed surrounding structures. She has recovered well from surgery. Of note, given the nature of C. sputigena as oral flora most commonly in animals, further inquiry was made into the immediate postoperative period following cesarian section and the patient’s home environment. The patient reports numerous dogs, which typically sleep in bed with her and her spouse, often resting their heads upon her abdomen.

Conclusion: Although post-surgical pelvic abscesses are rarely due to Capnocytophaga Sputigena, this organism has been documented to serve as a source of intra-abdominal infection. Factors such as contamination of surgical sites and an immunocompromised postpartum state can augment the potential for this unusual etiology. These infections may prove resistant to percutaneous drainage and require operative exploration and source control.

Methods:

Results:

Conclusion: