日本性感染症学会誌 Journal of Japanese Society for Sexually Transmitted Infections

Neisseria gonorrhoeae is one of the most common sexually transmitted infections, similar to Chlamydia trachomatis. In women, it is often asymptomatic as opposed to that in men. However, we report a case of gonococcal peritonitis with paralytic intestinal obstruction (ileus) that required surgical drainage because conservative treatment was ineffective.

An 18-year-old woman, high school third grader, was admitted to our emergency room with the chief complaint of severe lower-abdominal pain and nausea. She was suspected to have ileus and inflammation around the uterus. Thereafter, she was referred to our department. According to our detailed inquiry, she had undergone an artificial abortion. We observed tenderness around the uterus in our physical examination, and N. gonorrhoeae was detected from the culture of the vaginal secretion. Therefore, we diagnosed paralytic ileus caused by gonococcal peritonitis. After fasting and infusion control, we performed follow-up with antibiotics; however, the symptoms did not improve, and an abscess formed in the abdominal cavity. We concluded that conservative treatment was ineffective and performed surgical drainage and washing. After the surgery, the inflammation in the ileus gradually improved. The postoperative course was good, and she was discharged on postoperative day 15. Gonococcal peritonitis can cause infertility and ectopic pregnancy. Therefore, early surgical intervention should be performed if conservative treatment is ineffective.