未治療重症糖尿病を合併した骨盤内炎症性疾患に対し血糖コントロール後に腹腔鏡下手術を行った１例

抄録

Introduction: Pelvic inflammatory disease (PID) affects 4% of women, especially in younger age groups and occasionally, in patients with diabetes. We report a case of PID treated with laparoscopic surgery in a patient with uncontrolled type 2 diabetes mellitus.

Case: A 46-year-old nulliparous woman with diabetes visited our department for investigation and treatment of PID in year X-4. Bilateral adnexal hypertrophy was observed, and she was in remission with antibiotics. Subsequent recurrences were managed on an outpatient basis. In year X, the patient was hospitalized for antibiotic treatment because of severe recurrent PID. Blood tests showed elevated HbA1c (11.4%), prompting initiation of insulin. After 10 days, pre-prandial and 2 hour post-prandial blood glucose levels were controlled at 80-110 mg/dL and 140-180 mg/dL, respectively. However, no improvement in inflammatory response was observed; hence, surgical intervention was required. Emergency laparoscopy for left adnexal resection, right salpingectomy, and adhesion detachment was performed with an operation time of 3 hours and 23 minutes and an estimated blood loss of 400 mL. The patient was discharged 5 days post-operation.

Discussion: Around 60% of PID patients, with ≥ 10 cm adnexal abscess, require surgery. In patients with diabetes, it is crucial to maintain a perioperative blood glucose level of < 200 mg/dL to prevent complications. In addition, successful surgery is best achieved through the minimally invasive laparoscopic approach, which markedly reduces the risk of developing surgical site infections.