Chang Chi-Chen, Hsieh Yao-Yuan, Tsai Horng-Der, Lin Cheng-Chieh
Department of Obstetrics and Gynecology, China Medical College Hospital, Taichung, Taiwan.
J Assist Reprod Genet. 2002 Jan;19(1):42-3. doi: 10.1023/a:1014014807676.
Tubo-ovarian abscess (TOA), a serious complication of pelvic inflammatory disease, often require the antibiotic administration, surgical resection or the transvaginal aspiration. Pneumoperitoneum is often associated with the bowel perforation. We reported one case with TOA and pneumoperitoneum that have been mistaken for a perforated bowel with concomitant adnexal mass.
A 30-year-old diabetic Chinese woman was transferred for diffused abdominal pain, mild fever, nausea, and low-grade fever for 5 days. The sonography revealed a 5-cm adnexal mass. The chest X-rays revealed the pneumoperitoneum. Under the impression of bowel perforation and concomitant adnexal cyst, the emergent laparotomy was performed and the TOA was resected. No evidence of gastrointestinal perforation was present. Culture studies showed Escherichia coli without other bacteria flora. The postoperative course was uneventful.
We concluded that, beside the bowel perforation, TOA should be considered when a diabetic woman presents with pneumoperitoneum and adnexal mass.
输卵管卵巢脓肿（TOA）是盆腔炎的一种严重并发症，通常需要使用抗生素、手术切除或经阴道穿刺引流。气腹常与肠穿孔相关。我们报告了1例TOA合并气腹的病例，该病例曾被误诊为伴有附件包块的肠穿孔。
一名30岁的中国糖尿病女性因弥漫性腹痛、低热、恶心及轻度发热5天而转诊。超声检查发现一个5厘米的附件包块。胸部X线检查显示存在气腹。在诊断为肠穿孔合并附件囊肿的情况下，急诊行剖腹手术并切除了TOA。未发现胃肠道穿孔的证据。培养研究显示为大肠杆菌，无其他细菌菌群。术后病程平稳。
我们得出结论，当糖尿病女性出现气腹和附件包块时，除了考虑肠穿孔外，还应考虑TOA。
