Betty has been admitted in our hospital for poor feeding, abdominal pains, passing loose stool, vomiting.
She is a brest-feeding mother with a 1 year-old child.
She had been unwell for the previous 3 months always complaining of intermittent abdominal pains with excessive sweating. She had been admitted in other hospitals twice for the same problem.
On admission she presented wasted, weak, and unable to walk.
HIV test was negative. ESR 39 mm/1h.
The ECG was normal.
At FHG there was leucocytosis (WBCs 16000, of which 12000 granulocytes). HB 10 g/dl. PLTs 110,000/ml.
Urea and creatinine were in range. Electrolytes: hyperpotassemia at 5.8 mmol/L.
Urinalysis: urobilin +++; ket +/-; prot ++; leu ++. Pus cells seen in the sediment.
RBS= 6.5 mmol/L
She has oedema of the lower limbs and vaginal discharge.
Abdominal U/S: suggestive of PID, with pelvi-peritonitis. There are complex masses at the pelvis and there is some fluid between the intestinal loops. She has not passed stool for the last 4 days.
She has been on IV fluids; IV Rocephin 2 g OD for 5 days; IV metronidazole for 7 days… but there was no improvement.
I made therefore a provisional diagnosis of peritonitis secondary to PID.
We have taken the patient to theatre and we have found the abdominal cavity full of frank pus. There were a lot of adhesions between intestinal loops, possibly because of pus. In the Douglas there was a big abscess not completely drained in the great peritoneal cavity, and bilaterally there was pyosalpinx with oozing of pus in the peritoneum from the fimbrial ends.
We have drained the pus, tried to remove the adhesions which might have caused intestinal obstruction, opened the tubes and washed them with sterile Normal Saline: we have not done salpingectomy because the patient has only one child and she needs another one.
The post operation follow up is so far uneventful, and the intestinal sounds are now audible again.
I think that laparatomy has saved the life of Betty.
Bro Dr Beppe Gaido
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