術前診断が困難で腹腔鏡下手術にて加療し得た難治性骨盤腹膜炎の1例

抄録

Objective: Pelvic inflammatory disease (PID) is one of the most common infections in non-pregnant of woman of reproductive age; it involves inflammation of the uterus, fallopian tubes, and/or ovaries that can progress to scar formation comprising adhesions to adjacent tissues and organs. The treatment generally involves use of antibiotic therapy; however, surgical intervention may be necessary if the patient has tubo-ovarian abscesses. We experienced a case in which the diagnosis was difficult and the symptoms did not improve with antibiotic treatment. Laparoscopy was ultimately useful for both diagnosis and treatment of this PID case.
Case: A 35-year-old woman presented at a local hospital with the chief complaints of vaginal bleeding and proctodynia; no abnormalities were present. The next day, she was admitted to other hospital because of sudden onset of lower abdominal pain; laboratory studies were indicative of inflammation showing WBC 20,700 /μl and CRP 0 4mg / dl. Levofloxacin and piperacillin were administered. However, her symptoms exacerbated; computed tomography (CT) performed on the third day revealed ascites but no abscess formation. She was transferred to our hospital. A culdocentesis extracted purulent fluid. An abscess was not imaged with ultrasound; however, the left ovary was slightly swollen. Neither the right ovary nor the appendix exhibited any abnormalities. Laparoscopic surgery was performed for diagnosis and treatment. Acute inflammation of the pelvic organs, particularly in the left ovary, was present. The purulent fluid was drained, and the acute and inflammatory adhesions were excised; in addition, debridement of necrotic tissue was performed. Following the laparoscopic surgery, the inflammation promptly resolved and her postoperative course was satisfactory.
Conclusions: Laparoscopic surgery is useful for the diagnosis and treatment of PID that does not improve with antibiotic treatment.