Abstract
A 41-year-old female with no surgical history was treated at our hospital in 1991 and 1993 for lower abdominal pain. When intermitent hypochondrial abdominal pain suddenly occurred on the evening of November 7, 1999, and gradually increased, she visited our department of internal medicine. Marked tenderness in the hypochondrial abdomen and increased bowel sounds were noted, but she did not exhibit rebound tenderness or muscular defense. White blood count and C-reactive protein were within normal limits. Radiography and computed tomography (CT) of the abdomen revealed a dilated small intestine with air-fluid under the diaphragm on the anterior surface of the liver. After vomiting, and a diagnosis of ileus, a nasogastric tube inserted and the woman was hospitalized. Since abdominal pain persisted despite analgesics, she was referred to the department of surgery. Due to tympanism and metallic bowel sounds in the abdomen, emergency surgery was conducted for suspected internal hernia. Marked fibrous adhesion between the liver and abdominal wall with violin string, like funicular substances enclosing the small intestine existed was observed. The small intestine was retracted and the fibrous adhesion resected, curing of the ileus. Slight inflammation in the uterine appendages was noted, and a postoperative blood sample was positive for chlamydia IgA antibody 1.38 and IgG antibody 5.41. Based on intraoperative findings, we diagnosed ileus caused by perihepatitis apparently due to chlamydia trachomatis infection.
