Dhaliwal Anand, Razick Daniel I, Le Nancy, Akhtar Muzammil, Jakobsen Joelle
Surgery, California Northstate University College of Medicine, Elk Grove, USA.
Neurology, California Northstate University College of Medicine, Elk Grove, USA.
Cureus. 2023 Aug 11;15(8):e43339. doi: 10.7759/cureus.43339. eCollection 2023 Aug.
Peritonitis is inflammation of the peritoneum that can arise from a number of complications affecting the lining of the abdominal wall and organs. Acute abdomen and peritonitis is a rare complication in a previously healthy woman following a seemingly uncomplicated normal full-term vaginal delivery. We report such a case in a 20-year-old gravida 2 para 2 (G2P2) woman of Guatemalan descent, who presented nine days postpartum following an uncomplicated delivery, to the emergency room with acute abdomen and associated systemic inflammatory reaction. Interventional radiology paracentesis was performed, yielding a milky, purulent peritoneal fluid with no visible organisms and negative cultures. Antibiotics and paracentesis were insufficient in managing her condition, which continued to worsen over the course of several days. Given her continued deterioration despite clinical intervention, she underwent an exploratory laparotomy and peritoneal lavage along with continued broad-spectrum antibiotics. Cultures continued to be negative but operative findings included diffuse fibrinous peritonitis with no obvious abscess or perforated abdominal viscus. Following surgical laparotomy, she recovered fully without any complications. We review the available literature regarding peritonitis, discuss its management, and speculate as to its cause in this case.
腹膜炎是腹膜的炎症，可由影响腹壁和器官内衬的多种并发症引起。急性腹痛和腹膜炎在看似正常的足月阴道分娩后，在原本健康的女性中是一种罕见的并发症。我们报告了一例20岁、危地马拉裔、孕2产2（G2P2）的女性病例，她在顺产无并发症后九天，因急性腹痛和相关全身炎症反应前往急诊室。进行了介入放射学穿刺术，抽出了乳白色脓性腹腔积液，未见可见微生物，培养结果为阴性。抗生素和穿刺术不足以控制她的病情，病情在数天内持续恶化。尽管进行了临床干预，她的病情仍持续恶化，因此接受了剖腹探查和腹腔灌洗，并继续使用广谱抗生素。培养结果持续为阴性，但手术发现包括弥漫性纤维蛋白性腹膜炎，无明显脓肿或腹部脏器穿孔。剖腹手术后，她完全康复，无任何并发症。我们回顾了关于腹膜炎的现有文献，讨论了其治疗方法，并推测了该病例的病因。
