Uterine disorders Quiz: Ace Your Exams

A 28-year-old woman, gravida 1 para 1, presents to the emergency department with complaints of lower abdominal pain and foul-smelling vaginal discharge. She gave birth to a healthy female newborn 2 days ago. Vaginal delivery was converted into emergency cesarean section due to obstructed labor, and the placenta was removed manually. Past medical history is significant for pre-gestational diabetes mellitus type II as well as Neisseria gonorrhoeae cervicitis when the patient was 19, for which she was treated appropriately. Temperature is 101.4°F (38.5 °C), pulse is 100/minute, respirations are 19/minute, and blood pressure is 100/60 mmHg. BMI is 33 kg/m2. On physical examination, there is mild peri-incisional tenderness, minimal discharge at the surgical site, and no erythema or edema around the incision site. Foul-smelling greenish-yellow lochia is observed in the vaginal vault. Bimanual examination shows cervical motion and uterine tenderness. Complete blood profile shows hemoglobin of 12 g/dL and leukocyte count of 18,000/mm3. Which of the following is the most likely diagnosis?