Abstract
The patient, a 21-year-old woman, presented with severe hypogastric pain. Blood testing revealed the white blood cell count of 25500/mm3 and the C-reactive protein of 29.2mg/dl. An abdominal computed tomography did not reveal any clear free air but images did indicate small bowel ileus and a moderate amount of ascites. Transvaginal ultrasound-guided puncture yielded sticky yellowish-white purulent ascites. Panperitonitis due to gastrointestinal perforation was diagnosed and emergency surgery was performed. A laparoscopic approach was taken and a large amount of yellowish-white purulent ascites was noted throughout the entire peritoneal cavity. However, except for mild reddening and swelling of the appendix, no clear site of gastrointestinal perforation could be identified. The procedure was converted to open surgery for further close observation and drainage and irrigation, but no clear site of perforation could be detected. Only drainage and irrigation and appendectomy were performed. Culture of the ascites collected intraoperatively revealed Neisseria gonorrhoeae, and the final diagnosis of gonococcal peritonitis was made. The patient was prescribed 2 g/day of CTRX and 200 mg/day of MINO for seven days. She progressed well postoperatively and was discharged on the postoperative day 16. We hereby report on a case of gonococcal peritonitis upon which laparoscopic surgery was performed.
