2025 Volume 41 Issue 2 Pages 61-65
A 45-year-old woman with a 40 mm right ovarian cyst initially presented with fever and lower abdominal pain, leading to suspicion of pelvic peritonitis. However, examination of dynamic contrast-enhanced CT scan showed signs of pelvic inflammatory disease. Despite conservative treatment with antibiotics, the patient's condition worsened. Laparoscopic surgery and adnexectomy were performed, revealing yellowish-brown ascites and mild peritonitis, though no clear evidence of ovarian cyst rupture was found.
The presence of mild edema and inflammation in the right adnexa, left fallopian tube, and appendix led to their removal. Yellowish-brown ascites persisted even after extensive intra-abdominal lavage, particularly from the dorsal surface of the left upper abdomen. A BTB test paper, which changed color to blue, indicated alkaline fluid in the ascites, suggesting an intestinal content leakage.
Consultation with a gastrointestinal surgeon revealed a 3-mm perforation in the small intestine, with no signs of intraoperative injury, indicating an idiopathic small intestinal perforation. The perforation was successfully repaired, and the patient was discharged without complications. Notably, the use of the BTB test paper in the operating room facilitated an early diagnosis of small intestinal perforation in this case of unexplained generalized peritonitis.
