Korean J Obstet Gynecol.  2012 Apr;55(4):278-284. 10.5468/KJOG.2012.55.4.278.

A case of adhesive small bowel obstruction with pelvic inflammatory disease due to Chlamydia trachomatis

• Lee JE
• Kim M
• Choi H
• Ko JK
• Lee C
• Cho Y
• Kim B
• Yang K
• Kwon JE

• KMID: 1992627
• DOI: http://doi.org/10.5468/KJOG.2012.55.4.278

Abstract

A 17-year-old woman, who was hospitalized because of pelvic inflammatory disease due to Chlamydia trachomatis, developed emesis on 5th hospital day. On 7th day, vomiting and abdominal pain was aggravated. Plain radiography and contrast enhanced abdominopelvic computed tomography (CT) scan revealed small bowel obstruction with possible ischemic change at the level of the mid to distal ileum. Emergent exploratory laparotomy wad done and revealed adhesive band between small bowel mesentery and omentum, which resulted in closed loop and small bowel obstruction. Partial omentectomy, adhesive band adhesiolysis and incidental appendectomy was done. After surgery, the symptom was completely resolved with no further recurrence after outpatient department follow-up for 11 months. The present case calls for inclusion of abdominopelvic CT scan as well as plain radiography of the abdomen in the evaluation of pelvic inflammatory disease (PID) associated with emesis to detect bowel obstruction, rare sequlela of PID.

Keyword

Small bowel obstruction; Pelvic inflammatory disease; Chlamydia trachomatis

MeSH Terms

Abdomen
Abdominal Pain
Adhesives
Adolescent
Appendectomy
Chlamydia
Chlamydia trachomatis
Female
Follow-Up Studies
Humans
Ileum
Laparotomy
Mesentery
Omentum
Outpatients
Pelvic Inflammatory Disease
Recurrence
Vomiting
Adhesives

Figure

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  Fig. 1 Plain abdominal radiography. Upright (A) and supine (B) abdominal radiographs showed focal ileus in right upper quadrant and pelvic cavity and there is no small bowel dilatation and normal transverse colon gas shadow is seen on day 1 of hospitalization, whereas on day 7 upright (C) abdominal radiograph shows multiple air-fluid level (arrows) in small bowel and supine (D) abdominal radiograph showed dilated small bowel with no gas seen in colon that it meaned developing small bowel obstruction.

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  Fig. 2 Contrast-enhanced computed tomography (CT) scan. Axial (A) and sagittal (B) CT scan show no evidence of dilated small bowel on day 1 of hospitalization, whereas on day 7 axial (C) and sagittal (D) CT scan show dilated, fluid-filled small bowel to the level of an adhesion in the ileum and note the collapsed segment of bowel (arrows) that it meaned transition zone.

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  Fig. 3 The omentum shows multifocal abscess formation mixed with blood, fibrinous exudates (H&E, ×200) (A), areas of lymphoplasmacytic infiltration (H&E, ×400) (B), and the appendix shows lymphoplasmacytic infiltration predominantly along the subserosal layer (H&E, ×40) (C) H&E, ×400 (D).

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