Table 2.

Clinical timeline relative to the index cesarean

Time	Key symptoms/findings	Diagnostics	Interventions/outcome
POD 0 (index operation)	Elective lower-segment cesarean; early postpartum recovery on ward	–	Routine postoperative care; oral analgesia
POD 1–2	Routine postpartum course	–	Discharge plan; neonate admitted to NICU
POD 4 (readmission)	Progressive colicky abdominal pain, distension/bloating; subjective fever/chills	Labs: leukocytosis; rising CRP. Upright abdominal radiograph: bowel dilatation and free air. CT: pneumoperitoneum greater than expected	Empiric broad‑spectrum antimicrobials; inpatient monitoring
POD 6	Ongoing symptoms	Repeat CT: worsening pneumoperitoneum and fluid; radiologist suggested rectal‑contrast CT. Oral‑contrast CT: no contrast extravasation. Peritoneal aspiration: turbid fluid; neutrophil‑predominant; culture: ESBL E. coli	Continued antibiotics; surgical re‑evaluation given discordant imaging versus clinical trajectory
POD 10	Worsening inflammatory markers; persistent free air	–	Exploratory laparotomy: fibrinous peritonitis; ~ 2‑cm sealed cecal perforation. Primary repair + appendectomy + drainage; early postoperative course stable