Kaya Baris, Ince Alperen, Sam Ozdemir Merve, Yuksel Sercan
Obstetrics and Gynecology, Basaksehir Cam ve Sakura City Hospital, Istanbul, TUR.
Radiology, Basaksehir Cam ve Sakura City Hospital, Istanbul, TUR.
Cureus. 2024 Aug 6;16(8):e66315. doi: 10.7759/cureus.66315. eCollection 2024 Aug.
Surgery for deep-infiltrating endometriosis (DIE) carries a high risk of complications, including pelvic abscesses. We would like to present the laparoscopic management of a pelvic abscess caused by following a radical hysterectomy in a DIE laparoscopic surgery. A 43-year-old G2P2 lady underwent a laparoscopic hysterectomy, bilateral ureterolysis, bilateral parametrial nodule extirpation, and rectal shaving following complaints of severe dysmenorrhea, dyspareunia, and chronic pelvic pain due to deep-infiltrating endometriosis (ENZIAN score: P2; 02/3; T2/2; A3; B3/2; C2; FA) (American Association of Gynecologic Laparoscopists (AAGL) score: 72, Stage 4). She received intravenous antibiotic treatment at the hospital with a diagnosis of pelvic inflammatory disease one month before the endometriosis surgery. After the extensive laparoscopic surgery, the early postoperative period was uneventful; however, starting on the fourth postoperative day, she was complaining of abdominal pain. On the seventh postoperative day, severe left-sided abdominal pain, fever, nausea, vomiting, rising levels of C-reactive protein (CRP > 200 mg/dL), and signs of septicemia were observed. The vaginal examination revealed a purulent discharge. Bacterial cultures were obtained from the vaginal cuff and peripheral vein. On the computerized tomography scan, neither a bowel nor ureter injury was found, but a pelvic abscess above the vaginal cuff and left ureteral compression below the pelvic brim were observed. Due to the clinical deterioration of the patient despite receiving piperacillin/tazobactam antibiotic therapy, the decision was made to perform a repeat laparoscopy to prevent septic shock and ureteral stent application for urinary tract obstruction. During the laparoscopy, purulent fluid was discovered around the pelvic peritoneum, and it was noted that the rectosigmoid colon was edematous and tightly adherent to the pelvic sidewalls. The rectosigmoid colon was carefully detached from the pelvic sidewalls; the left ureter was released, and the purulent abscess material from the vaginal cuff was aspirated. Every effort was made to remove as many yellowish plaques covering the pelvic peritoneum and rectum serosa as possible. Recovery following surgery was rapid. was detected in the blood culture, and the patient was treated with piperacillin/tazobactam for an additional seven days, resulting in a complete resolution of the illness. Pelvic abscess is a rare but serious complication that can occur following laparoscopic deep-infiltrating endometriosis surgery. To prevent ending up with septicemia and septic shock, further laparoscopic surgery may be necessary.
深部浸润型子宫内膜异位症（DIE）手术并发症风险高，包括盆腔脓肿。我们想介绍1例DIE腹腔镜手术后根治性子宫切除术后盆腔脓肿的腹腔镜处理。1名43岁、G2P2的女性因深部浸润型子宫内膜异位症（ENZIAN评分：P2；02/3；T2/2；A3；B3/2；C2；FA）（美国妇科腹腔镜医师协会（AAGL）评分：72，4期）出现严重痛经、性交困难和慢性盆腔疼痛，接受了腹腔镜子宫切除术、双侧输尿管松解术、双侧宫旁结节切除术及直肠剥离术。子宫内膜异位症手术前1个月，她因诊断为盆腔炎在医院接受静脉抗生素治疗。广泛的腹腔镜手术后，术后早期恢复顺利；然而，术后第4天开始，她诉说腹痛。术后第7天，出现严重左侧腹痛、发热、恶心、呕吐、C反应蛋白水平升高（CRP>200mg/dL）及败血症体征。阴道检查发现脓性分泌物。从阴道残端和外周静脉获取细菌培养样本。计算机断层扫描未发现肠道或输尿管损伤，但观察到阴道残端上方盆腔脓肿及骨盆边缘下方左侧输尿管受压。尽管接受哌拉西林/他唑巴坦抗生素治疗，患者临床症状仍恶化，决定再次进行腹腔镜检查以预防感染性休克，并置入输尿管支架以解除尿路梗阻。腹腔镜检查时，发现盆腔腹膜周围有脓性液体，直肠乙状结肠水肿并与盆腔侧壁紧密粘连。小心地将直肠乙状结肠从盆腔侧壁分离；松解左侧输尿管，抽吸阴道残端的脓性脓肿物质。尽可能多地清除覆盖盆腔腹膜和直肠浆膜的淡黄色斑块。术后恢复迅速。血培养检测到[具体细菌名称未给出]，患者再接受7天哌拉西林/他唑巴坦治疗，疾病完全治愈。盆腔脓肿是腹腔镜深部浸润型子宫内膜异位症手术后罕见但严重的并发症。为预防败血症和感染性休克，可能需要进一步的腹腔镜手术。
