Abstract
We herein report on a case of acute abdomen, as the first presentation of spontaneous bacterial peritonitis caused by Neisseria gonorrhoeae, which was treated by laparoscopic drainage. A 20-year-old woman attended the emergency room with severe lower-abdominal pain and fever. CT imaging showed bowel dilatation. Obvious findings of appendicitis were not found. Since her sex partner was found to have a history of recent treatment of gonococcal urethritis, and her vaginal discharge was purulent, pelvic inflammatory disease (PID) was strongly suspected. After collection of endocervical specimen, the patient underwent laparoscopic drainage, which showed her pelvic cavity was covered with yellowish-white pus with hyperviscosity. Ceftriaxone sodium and minocycline hydrochloride were initiated, and the post-operative course was uneventful. She was discharged on the 4th post-operative day. N. gonorrhoeae nucleic acid was identified from her endocervical specimen, which was negative for Chlamydia trachomatis. Gonococcal peritonitis is relatively rare but causes intense pain, and it should be considered as a possible cause of acute abdomen. Laparoscopic drainage could be useful not only for making the correct diagnosis of PID, but also to prevent peritoneal adhesion and shorten the hospital stay.
