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Abstract: Xiao Tian, 27, came to the hospital with chills and high fever and lower abdominal pain for 2 days due to intercourse on the 3rd day of menstruation, and was diagnosed with pelvic peritonitis after gynecologic examination as well as laboratory tests. After admission, the patient’s condition was clinically cured through active drug combination therapy. Pelvic peritonitis is mainly caused by postpartum, post-surgery or menstrual sex, so it should be taken seriously.
Basic information】Female, 27 years old
Disease Type】Pelvic peritonitis
Hospital】Guangzhou Huadu District People’s Hospital
Date of Consultation】December 2021
Treatment plan】Medication (Ceftriaxone sodium for injection + metronidazole injection + energy combination + compound amino acid injection)
(18AA) + compound aminopyrine injection + penicillin sodium for injection) + physical cooling + vulva care
Treatment period】13 days of hospitalization
Treatment effect】The condition gradually stabilized and the indexes gradually returned to normal.
I. Initial consultation
Patient Xiaotian visited the clinic with high fever and chills and lower abdominal pain for 2 days. She had a history of sexual intercourse on the third day of her menstrual period. Two days later, she developed lower abdominal pain, which was progressively aggravated and worsened every time she urinated or defecated, and had two episodes of loose stools. She came to the hospital because she mistook dilute stool for enteritis, so her symptoms did not ease after taking Baoji pill.
She had no abnormality in the upper abdomen and no abnormality in the lower abdomen below the umbilicus with rebound pain.
Gynecological examination: light red vaginal discharge with great odor, cervical erosion of degree I, no congestion and edema on the surface of the cervix, painful cervical lifting (+), normal size of the uterus, pressure pain (+), significant thickening of the bilateral adnexal area with significant pressure pain. Vaginal color ultrasound examination showed a large amount of fluid in the pelvis, no mass in the uterus, and no fluid in the fallopian tubes. Routine blood test: white blood cell count was 11.20×10＾9/L, neutrophils: 80.54%, negative urine pregnancy test, normal clotting time, biochemical examination: potassium: 3.15mmol/L, other normal. Posterior fornix puncture extracted yellowish fluid sent to the laboratory for bacterial culture plus drug sensitivity test, and the result after 3 days was: E. coli infection, penicillin and ampicillin sensitive. Combining the above tests, the patient was diagnosed with pelvic peritonitis.
II. Treatment history
After hospitalization, the patient was given primary care, monitored blood pressure, pulse, temperature, respiratory changes, bed rest, vulva care twice a day, intravenous injection of ceftriaxone sodium plus metronidazole injection combined with medication treatment, and static energy combination and compound amino acid injection
(18AA) to improve the patient’s condition. On the day of admission, the patient’s body temperature was as high as 40℃, and he was treated with intramuscular injection of cotrimoxazole injection to reduce fever, and physical cooling was given at the same time. On the 5th day of hospitalization, the body temperature was 37.5℃-38℃; on the 8th day of hospitalization, the body temperature dropped to normal, and the lower abdominal pain was obviously relieved, but the patient still felt pain in the lower abdomen every time he had a bowel movement or urinated, and was instructed to continue the medication.
III. Treatment effect
On the 13th day of hospitalization, the patient’s body temperature dropped to normal, the vaginal discharge was milky white with no odor, the cervix was painless, the uterine adnexa was painless, and the lower abdomen was painless and rebound. On the same day, ultrasound examination of pelvic fluid of 1.0 cm, biochemical examination and routine blood examination were normal. After 13 days of combined drug treatment, the patient’s condition gradually stabilized, the pain in the lower abdomen disappeared, the vaginal discharge had no odor, the body temperature returned to normal, and the indexes gradually returned to normal, so she was discharged.
IV. Notes
The patient recovered well after the treatment, and we are happy for her. It is recommended that the patient continue to rest for 1 week after discharge. It is recommended to observe the color and smell of vaginal secretions, not to have sex for 1 month after discharge, and to strengthen local care of the vulva, keep it clean and change underwear regularly to reduce infection. She was advised to pay attention to menstrual hygiene, change sanitary napkins regularly, strengthen vulva care, and prohibit sexual intercourse and bathing during menstruation.
V. Personal insight
The patient had intercourse during her menstrual period, which led to pelvic peritonitis and caused great pain. This is mainly due to the lack of hygiene knowledge and the misconception that menstruation is a normal physiological period, so it leads to wrong behavior. Since women’s resistance decreases during menstruation and the endocervix is relatively loose, bacteria can be brought into the vagina during sex, and menstrual blood in the vagina and in the uterine cavity is equivalent to a bacterial culture medium, causing bacteria to multiply in a short time and spread to the pelvis and peritoneum. Therefore, women should pay attention to physiological hygiene during menstruation and reduce the wrong behavior to reduce the damage to the body. If pelvic peritonitis occurs, once the treatment is not complete, it may lead to infertility and even threaten the life of the patient.