Two cases diagnosed as pelvic inflammatory disease from Chlamydia during laparoscopic surgery for appendicitis

Abstract

  A significant percentage of patients diagnosed pre-operatively with appendicitis are shown to be normal during laparotomy. Laparoscopic surgery is useful for both diagnosis and treatment of acute abdomens.
Herein we report two cases diagnosed with pelvic inflammatory disease (PID) from Chlamydia during laparoscopic surgery for appendicitis.
Cases: Case 1: An 18 year-old woman visited our hospital with abdominal pain. A CT and MRI revealed a large abdominal tumor and appendicitis. Laparoscopic surgery was performed.
During laparoscopic cystectomy and appendectomy, we observed fibrous adhesions forming violin string-like sheets between the liver surface and the abdominal wall. Later, a cervical swab test for Chlamydia trachomatis by polymerase chain reaction (PCR) was positive and a serum test was positive for anti-Chlamydia IgA and IgG.
Case 2; A 26-year-old woman with no surgical history visited our hospital for evaluation of lower abdominal pain. Marked tenderness in the hypochondriac region was noted. The white blood count and C-reactive protein level were elevated. CT image revealed an edematous appendix and right adnexa. Laparoscopic surgery was performed, and an edematous appendix and inflammatory changes in the right adnexa were noted. Subsequently, Chlamydia trachomatis was confirmed by PCR and serum test.
Conclusion: Without an increase in costs, laparoscopic surgery provides clinical advantages. Initial laparoscopic surgery reduces the possibility of misdiagnosis. We recommend laparoscopic surgery as a first choice in the management of an acute abdomen.